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TALUS WEST BLK 1 LT 9
Talus Block I Lot 9 #015-201-32 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231059 PID Number: 015-201-32 Dwelling: A Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name EDWARDSEN ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑j Bed ❑ Mound Site Address 11915 WILDERNESS DR ❑ Other Phone Number of Bedrooms Soil Rating Total depth frgm original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot TALUS WEST BLK 1, LT 9 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES ToTotal Septic Absorption Lift Station Holding Sewer absorption area Number of trenches (Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ 50'+ TANK ❑ Septic N S.T.E.P. ❑ Holding ❑ other Manufacturer Capacity ANCH TANK 1500: Gal. Surface Water 100'+ Material Number cf compartments Lot Line 10'+ NA STEEL 2 Foundation 0'-} LIFT STATION Manufacturer ANCH TANK Capacity 1500. Gal. Remarks TANK DEMO PER UPC, NO CONCRETE BALLAST USED, DRY HOLE Alarm location EAST EXT WALL Electricaljinstalled by BR1QKS ELECT. PIPE MATERIAL House to tank 3034: Tank to 3034 drainfeld Installer MIKE N ANDERSON, P.E. DrainfieldCo/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspdectionates i51 4/':4/23 Location and description nd 2 TOP OF MANHOLE 100 3b 41^ ON-SITE WATER AND WASTEWATER SECTION APPROVAL En 9i eer's Stamp Conditional Approval: Date .i • 9 'T �'•'` �,� :�:�<; Septic Systemf Approved //� Date i�� Not this approval does not include well permit require nts� (Rev 05/02/7 f Permit No. OSP231059 Page 2 of 2 Municipality of Anchorage 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 Legal Description: TALUS WEST BLK 1, LT 9 / I I I 1 1 y� / / I I 1 1 Y I I I I I 1 \ WELL MARK A B C01 \ 15 26 TC01 \ 10 37 TCO2 \ I I I 17 44 I FOOTI DRAIN CO i ALL i i *1 TCO2 V WELL i' I I \------' ASBUILT I I SCALE: 1"=50'/ SEPIC SEC71ON N.T.S. PID No.: 015-201-32 NEW 1 00 GALLON EL TANK BgNCHMARK TOP F LID MOUND NO WORK 150' WELL RADIUS W/ ADEC F Al AV Gj�,• AN 49 TH MICHAEL N. ANDERSON: ' No. CE 9469 W 0 0 N ro �n 0 0 0 0 0FAt gs�o 49 TH0� s SHANE A. HOLT �� t LS -6914 �..... Knn°fessiona\ N 89 54' 42" E 175.97 cn z Q LFA o qL n a � n 51 m 0.8 Q C_ N ewe« ,_ m N 86 19 6F'-- w 177. 18 • • AS -BUILT SURVEY SCALE 1 "= 20 ' I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY NO CORNERS SET THIS DATE LOT 9, BLOCK 1, TALUS WEST SUB. THE INFORMATION HEREON IS FOR THE USE DF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS NOTTO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD. OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _ 17 TH DAY OF APRIL , 2023. 2787, FB 166-4 231-19 HOL T LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 9072238615 M �n 0 Q) Q) Z MUNICIPALITY OF ANCHORAGE �»ent On -Site Water & Wastewater Program �o PO Box 196650 4700 Elmore Road i Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 ` http://www.muni.org/onsite f q E llehartmeut 'v�H ORP' On -Site Wastewater Disposal System Permit Permit Number: OSP231059 Effective Date: 4/12/2023 Work Type: SepticTank Upgrade Expiration Date: 4/11/2024 Tax Code Number: 01520132000 Site Legal Address: TALUS WEST BLK 1 LT 9 G:2736 Site Mailing Address: 11915 WILDERNESS DR, Anchorage Owner: EDWARDSEN BOBBYJO Lot Size in Sq Ft: 18630 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing i Received By: S% 0 `' c✓ C - Issued By: ( A Date: Date: ON-SITE SEPTICMELL PERMIT APPLICATION Parcel I.D. 015-201-32 Property owner(s) BOBBY JO EDWARDSEN Day phone Mailing address 11915 WILDERNESS DRIVE, ANCHORAGE, AK 99516 Site address 11915 WILDERNESS DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) TALUS WEST BLOCK 1, LOT 9 Legal description (Township, Range & Section) Lot Size 18,630 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: ([D all that apply) Absorption Field E] Initial F] Single Family (SF) El Septic Tank nX Upgrade nX (w/wo AD U) Duplex (D) EJ Holding Tank F] Renewal Multiple Dwellings ❑ Privy El (SF and/or D) Private Well n Water Storage El THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. nature of property owner or authorized agent) Permit/Rush Fees: I ?, 2- S Date of Payment: I I it/ 292 Waiver Fees: Date of Payment: Receipt Number: }111 � t I Receipt Number: Permit No. C) _S P -2- 31-o Waiver No. GADevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTennit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! April 6, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK – STEP UPGRADE PERMIT LEGAL: TALUS WEST BLOCK 1, LOT 9 We have been requested to obtain a septic permit to upgrade the existing aged steel septic STEP tank on the above referenced lot. Per the attached design, a 1500-gallon epoxy-coated steel septic tank and anchored with 4 cubic yards of concrete is proposed to serve the existing 4- bedroom residence. The existing STEP tank is approximately 96 from the subject well with a MOA waiver obtained previously. All well radii to the proposed septic STEP tank will be staked prior to construction and the new proposed STEP tank will be installed 100+ from the well serving this property. The lot and area are served by private wells including a private shared and noted public class C well with previous 150 ADEC waiver. However, it is also noted and per MOA files, the well(s) serving the Borealis subdivision is classified as a Class A which as stated previously the septic system on the referenced lot already has an existing ADEC waiver as well do other on-stie septic systems on other lots. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231059, Curtis Townsend, 04/12/23 FIRST WATER CONSULTING NO PRIVATE WELLS WITHIN 100' OF PROPOSED SEPTIC TANK. STAKE WELL RADII PRIOR TO CONSTRUCTION. TALUS WEST BLOCK 1, LOT 9 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231059, Curtis Townsend, 04/12/23 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF 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 Name DISTANCES '~'~/'~ FRO~ SEPTIC ABSORPTION Address ¢ ~ .~ TANK FIELD WELL LEGAL DESCRIPTION I ~/~ ~ 0 LOT LINE / ~ ~ Township..ange, Section I l ~.~; j~, ~ ~ driveway, water bodies, etc } · '' TANKS Il N ' ~ SEPTIC ~ HOLDING ~4 Manufacturer ~apacity in gallons Matedal J i .0 Compa~ments * , ~: ~ ~ ~ ~ ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~C* °riginalgrade ~ ~ / F~ ~ ~a~' ~ / '~ ~,~ I G~avel dep eneath pipe Fill a~above original gra~ ~ FI ~,~ FT W'~ J ~ ~0 FT ~ 0 FT ~ PRIVATE D OTHER ,ldentifv~ ~1 ~. InspectionsPedo edby: S & SENGt NEE RING cedily that Ibis inspe~ion was gedormed according to all ' ~ ' ' ~ '~ Heallh Depa~menl Approval; Dale: 72-013 (3/85) :::; '"~ '! i:).,.:.::,p'bh ~;_. 'L,::,p c*F %c:,.p(:i.~:: 'Lank(!:s) '::: iEi'I(3]:Nh,E:D: IE,I i:;'.F'FI'I~: F: Z[lJ,., L,),"YlED )3iEI',IE:.PFT'I'[ F:'I_:H::~P~ ,,t "t' W~I.,. :[ :O (.tP, I] :[ I,. ~:)l:~:(::;liii:['"![3[:ii:!::,: :3 :i..~, ~ 990 ,, DH:S[G!q ~'~d::'PI .... F,',P.'f'E EhqSEL:t,) [:)N ,LI:I:~iJHE:.ST l-:~¢ffE:~:) ~-;;[:):[L.. t.,.E:VI:::L ~IEL,,Ot/.J [E~Y'S'FE:H !i:N(..~]:ix[l:33:;', PiLiSI' GE:F';.'T]:I:::'Y i3/'.~S~.:~k 1'4¢tF!i:F;'.:[¢~L. .i.S 515'X CE)PII:::'¢:~CXI'[i:~') 'ICi CE)I"IF:'L,E~:-f ]: t3N E/F: ]: .I'qC~T¢:~L.,L.F..VFZ E)I',! :, (:;l::i:!::Ri :I: F; Y 1'1'"k'I I'~ ~:c~r't:.h by 'LBS! NLu'i.tc:i. pa.].:i.'Ly (::,f i:)i3E[i/J]i"~.(~jE~ (["IE)~::~) and 'Lbs) and ¢.ri c:c~mp:i.~i, anc:~:, ~.,,¢?t'..h ~:.f.~ d(~:;H~ij, gFI ¢:P;i.~Le?i':ia~! of 'bh:i.?.~ :3,, :t: ~.,xi.:l. 1 adhsH*c.) 'Ecl a].~ FI(:](.:~ al'id ii!J~'.a'~.o (:)f ~:.~].a'x!iiik,.'::( t'~Ff(:'lt..].~,l"(:;)/¥1i'::)l"i'~'.,!Ei !B(;~,?~)l'~'¢q:ij~2 !E;yEFI:.~,[¥t (::~1") 't'.hJ.!B I::H" Ed'!y ,~Ei.jEtC;6:e~'t:. (9? f"~6):e~:?,P[:!y ;*..i.!s:.cl !.U"~(::h;H'!~:FLaW'~cl 't'.haL Ch(ce i:::apatc::i.'Ly o'[' 'Lh(a 'l:.~.)'La:l, !~ysll;:f-.(;!el'~'l :[s~ 4. b(;i, ch".c)Qm!sl and any r.::,n ].ai,,g~am, i.rgrvL i4'J. :[ ]. (,'::lu,!n ¢~! r' ) · F-- (ENGINEER'S SEAL) ~ Mumc~pahty of Anchorage ~/ 825 "L" Street, Anchorage, Alaska 99502-0650 WAS GROUN~ WATER ENCOUNTERED? Moniloring? ~ Dale: 11 IF YES, AT WHAT DEPTH? 12 13 14 15 16 17 18 19 Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLA HOLE DIAMETER __ ~ TEST RUN BETWEEN FT AND __ FT PERFORMED~. S ENGINEERING ~ ~ERTIFY THAT T~IS TEST WAS PERFORMED IN [::h,,.mi~:'P Iq.r,wn¢.z,~ i:: Iq I'! ~ D.5'~.y Ki,t,,n'~(~:.!r'.~.l t.l~'~ < ....:320 J C c:! [ h c:) :[ d J ri,':] J: ,'Lii-!i:!:i'.T]J!'"Y 11..I,/..~'1",] :i,. ]: am FamJ. lJ. ar' !^~:i,'i:.l'l 'Lh(;~ i'f~qLtJ, i'(em¢_,n'l:..~i ,x',.'::H' cm~....!i~i:i.t.s~ ~iiie)we~H~.!~!i ~::~['t(:! wia].]i.~[~ a~i si(at. · .:~,, :t: ~/,~:i.].]. .::'~dh(:¢n~) 'Lc) a].:[ t'dEl¢~ and S'La't:.E, SCALE ROBERTSHAFER, P.E. ROGERSHAFER December 8, 1989 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS Ms. Kri~ K~rtz JACK WHITE COMPANY' 3201 C Street S~te 100 Anchorage, Alaska 99503 REFERENCE: Lot 91 Block II Tal~s W~t Subdivi~lon; Kris, At your 'request we ~xamined the' r~idence located on the referenced property 'to d~t~rmine an appropriate cost for d~pproofing the foundation ~ to ~iminat¢ water in the b~ment ar~a. _ The house constructed on this prop~u~y ~s 2 story, wood fram~ stru~t~r~ constructed on a CMU foundation wall and supported by r~inforced concrete footings. The r~idenc~ is s~rved by an on-site wast~t~r d~spos~ system. At the t~e of this inspection the following observations w~re made. I. There was approximat~y 2 inches of standing water on the basement floor. When w~ first ~d th~ hom~ to ~x~in~ th~ w~r in th~ ba~ a v~y strong sm~ of ~g~ ~ pr~. From t~ w~ ~u~pe~d t~ th~ ~ in th~ bas~ ar~ ma~ not b~ from groun~ l~ng ~r~ in through th~ foun~on ~4. B~ ma~ possi~l~ b~ groun~ w~h i~ e~in9 th~ r~id~nc~ through th~ ~p~c Syst~. 2. Th~ floor drain Ln the u~ty room wa~ covered with water and app~rgd t~t ~om¢ s~ge ~d ~nt~gd t~o~gh th~ floor dr~n. 5. The~ mo~o~ng t~b~ in thc ab~orp~on fi~d in the back ~ard w~ ~in~d and found t~ ~ ~d compl~ f~d t~ w~ had ~tood in th~ pip~ ~ l~v~ a~ov~ th~ ~ro~nd 4. An ~on of th~ ~ft ~on/sep~c ~nk ~how~d ~ ~ta~ng in th~ s~p~c ~nk aSov~ th~ th~ top of th~ ~nk and up into th~ ~4~ for th~ ~ft s~on. ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 e Two. Lot 9~ Block ~ T~ We6t Sabdivi6ion~ l~eeembe~ 8, 1989 The ~eanout n~t to the foundatlon ~a~ wa~ ~tandlng fu~ 6~ water. we notZfZed ~oa o~ ,thi6 condition, yoa ~d the 6ep~a ~n~ p~ped and poZ~ Zn ~e, w~ 6ugg~t~..to ~oa ~ ~o~ ~ve ~he ~nk p~ped ag~, and ~o~ ~ue p~g~ p~ in th~ ~loor dr~n in the b~e~ ~. ~e ~gg~ed t~ ~oa ~ue the g~ ~ned ba~k on a~ the bo~ p~e~ option ~o d~ o~ the i~ide o~ the hoaae. Fro~t ~ g~h~ng on the and the .~ on the ~oo~ ~a .~Mng to Zee. returned to the ho.~e ~euera~ 'da~a t~ter and again ~ound that the ~t 6~on/6ep~a ~nk ~ aompl~M~ ~ o~ ~. ~, a~u~ed the ~ 6~on b~ ~ng the br~k~ on in the garag~ and p~ping th~ ~t~ o~ of the ~ft 6~on l~o ~ ab6orp~on b~d. Tha ~no~ n~t'to th~ ~ft 6~on ~6 ob6~u~d-~ng t~ option and ~ th~ p~p eua~ed th~ ~ft 6~on ~ ~e up in th~ ~no~ abou~ the ground leu~. The ~ft 6t~on ~ p~p~' o~ a~ the ba6~ began to ~ o~ to. the ~i~e, ~ ~ ~ed t~ thee ~ I~6 tMn I f~. o~ ~er le~ ~n the ~t 6aon ~ t~ poi~. ~e we ~oand t~t the ~t ~on ~ a~n ~ o~ ~. r~v~ed the ~ft ~on p~p and ~p~ed the ~nk ag~n. Each ~e the ~nk been ~p~ed ~e w~e able to d~e~ed ~t~ l~ng l~o the ~n. T~a app~red to be a~oand the ~onne~on b~een the ~ and top o~ the Sin~e t~6 6y6~ ~6 l~t~ed in Ma~ o~ 1989, ~ ~d not 6e~ r~6o~ble ~ho~d be in ~ ~e o~ f~re at the pr~e~ ~e.. Howeu~, ~ ~ obuiou~ groun~ ~d ~mpl~ 6~ed the ~6t~ and ~ the ~e of, l~t ~ pa~ of the ~ t~ ~d f~ed the ba~e~ ~. MUNICIPALITY OF ANCHORAGE '~ DEPARTMENT OF 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 F'I~ H MI~E .4/I i~- AILZ4.¢ ~" F4 DISTANCES Address ~ SEPTIC ABSDRPTIDN TANK FIELD WELL PhOnelst~.~/. (,~_]~o~ ~.~(~ Permil No¢,~000 ~ IN°~-,LBed~°°m~ WELL LEGAL DESCRIPTION LOT LINE / '~L U~ ~o~ ~'T FOUNDATION AS-BUILT DIAGRAM {Show Ioca ~on o ~ e , septic system, property lines, foundaUon 'TIz 8 ~ -~ ~ ~ ~Z dr,~eway, water bodies, elc) TANKS ,, , ~ ,J ~,'~ ,,., I,, ,, J ~ ~-f TYPE OF SYSTEM 2 CH BED ~ W. DRAIN ~ OTHER 4' Jr~ Total absorpUon area Distance betwee~ Jines ~ WELLS K, ')o' ~ PRIVATE ~ OTHER ,Identify) 72 Inspections Pedormed by: ~J~-)~ ~[~J~ ~.1~0~1~ ~ ~ I~C~-D, Date: . ~unicipal and Stale guidelines in effect 0n this dale: % ~¢ % ~ '-~ Health Depadmen, Approval: / ¢ Date:F--2 ~- ~¢ F'e~-mi'L Numbe~': O~,,~n,~.~- Name,".. I::, N,, Iq. A., OwneP Addr'ess,~ 320]. 'C' STF;~EET ANCHL3F/AGE~, AJ'::: 99503 Day Ph(~ne~ F:'a r' (:: e ]. I d: 015.-20 ].,....32 !..crL L..egal: SL~bd:Lvf. siclr'l: TAL. US WEST L..~t: 9 Block: Sec:'L ion: 22 ]"o~,m,~h ip: J. 2N Rang~: 3W L.o'L S:Lze 4()()00 (sq. ft.. of acr'es) Max Bedpoc)m~: This Per'mit: 4 'f'otal Capac:L'Ly: 4 SLEF:'Y:i:C 'TANK: Mf.r'~imum 'Lo'LaI septic tank t. ank mus'L hav~, a'L :Least 2 cctmpartmerrLs. fee'(:. P~qt_tf.r'.es :i. nsL~iat:Lc~n ovel~ 't. ank (s) . capacity: 1,250 ga].].cH']s. Eac:h septic Depth {o tap o£ septic 'Lank(~s) < zl-.O ~NSTAL..I... PER APPR[)VED DE:S:[GN~, SEE.:: AT"FACHMEN'T'. NOT!FrY DHHS PFCI:OR :f'[] EACH IIqSF'ECT:!:ON BY ]'HE ENG Z NEER,, MAX IIdLJM DEF:"I"H -'"-:]; ' . "f'I"'I]:S ~PERMIT :IS ISSLJE~:D Fq;)R THE: tEXtSTING 4 BEDROOH SINGL. E F:'AMILY RES,, jONLY AND EXPIRES ON :[2/3:L/89,, F:'ROVIDE A C:DPY OF' THE EL.EC;'I"ICAL ~INSPECTION WITH AS"-BUIL, f',, ii: CERTIF:'Y THAT: J.. .[ .~t~l f'a~lJ.].J~r' ~j.'l:.h t.J'tet P~qL~iP(e~E~)rYLEi f'oP C]~]--E~J.'I:.E~ s(e~E)r's ariel ~c,r't.h by ¢.he MLu"i:[cipal~.ty a{' An[:hc~r'age (MOA) ~nd 'Lhe St, ate of Alaska. 2. ]: ~,¢i:l:L insta:!.~ 'Lhe system in accopdance ~*d. Lh a:Ll MOA codes and J'egu].at:Lons, arid ~rl c:~]ml_~iaric:e vgJ. tl'l the dessgn c:p:L'Lep:La of t.l'lJ.~ per-m:Lt. ~;. ]: t,l~J.]], adher, e t.c~ all MOA and StalLe of A:Laska Pe~(:]L~:LP~InE)FYLS f'C)P distarlces f'Pom any exis'Ling ~4e].l, waste~ater disposal sys'Lem or' public ~eWel'ag¢<.? sys'Lem on this ol- any adjacent, or' neapb.y lcrL.. ]: under, stand tha'L 'Lhis pepmi'L is valid Car' a maximum of 4 bedr'ooms. alE;(:;) LU'ICIG)I"~tBI']d 'tLhat '~.J-IE~ c:apaci'Ly of' the t. ci'LaZ system ]Ls 4 J]EtQPCJf]~IilE~ al]cJ PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 6- 7 8 9 10 11 12 13 14 15- 16- 17- 18- 19 20 fCLL I 'Tf!Lb'.~' .' ' .~/~'V Township. Range, Section: 'T-/z/k,l ~ .~'~,,,! ~g' ~ ~_ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth '° Water Afler/bt~__~- I~onilorin§? Bate: Reading Date Gross Net Depth to Net Time Time Water Drop /./~,1~ I~m,~, I~.../~. ,~.o7 ~,,~ O, ~ ~ PERCOLATION RATE ~ Z~(mrnules/inch) PERC HOLE DIAMETER TES~RUN ~ETWEEN ~t (~'''~ FTAND ~ FT ?2-008 (Rev. 4/85) :~"~ L~Q,t~,~,~o ~ , ~// r~:,~ I ' ~' ~ ~ x . , . I / / /'" Zd~O/ ~' /~ ~ · , ,' ~II :' ~- ~- ~P~ = ~o~. s ~' l~ :~ ~1~.5}~'~>~ ~EWER SYSTEM LOOATION PLAN: Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SEF~I 825 "L" Street, Anchorage, Alaska 995'02-~ SOILS LOG -- PERCOLATION PERFORMED FOR: ~'t~klM1F ..&I ,~ E LEGAL DESCRIPTION: '~ L V ~ F'~ /~-~ / SLOPE 2 5 6 8 10- 11 WAS GROUND WATER ENCOUNTERED? ,,'~,~.' , ~',.,./J %¢ '.'~,.~ ~ , ,., ,,,,. ,¢ ALITY OF ANCH( )RAG,E )5, Township. Range. Section: ~/Z ~ ~ ~J ,~'~ ~ IF YES, AT WHAT DEPTH? ,% 14 15 16 17 18 19- SITE PLAN s Reading Date Time Time Water Drop ~-/~/~, 12:/o ~.c~' / ', IZ:ZO I0.~;,, ~.4/' ./cf' ~ ,. Iz:4o /~,.~ o~" . /~' 1~:~ ~.~' PERCOLATION RATE ~' °(2~'- (m~nuleslinch} PERC HOLE OIAMETER TEST.RUN BETWEEN FT ANO ~ FT CORWIN & ASSOCIATES, INC. 1000 E Dimand Blvd. Suite 205 ANCHORAGE, ALASKA 99518 (907) 522-1311 SHEET NO. OF CALCULATED BY DATE SCALE Y. South Fork Construction P.O. Box 770567 · Eagle River, Alaska 99577 · 907-694-4551 ~iAY 3, ]989 LOT 9, BLOCK 1, TALUS WEST SUBDIVISION 11915 WILDERNESS DRIVE DUANE W. WERT INSPECTED THE ELECTRICAL WIRING AND TER~-fINATIONS OF THE ADD-ON LIFT STATIONS FOR THE UPGRADE OF THE SEPTIC SYSTEM OF LOT 9, BLOCK 1, TALUS WEST SUBDIVISION, 11915 %fiLDERNESS DRIVE. ALL WIRING MEETS ELECTRICAL CODE. SOUTH/FORK CONS~UCTION DUAK~ E. WERT STATE OF ALASKA ADMINISTRATIVE LICENSE %D778658 CERTIFICATE OF FITNESS ~880415 ~UNICIPALITY OF ANCHORAGE and Environmental ProteO~,~n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ONLSITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS J ~)OC) C,,~.] ~ '~,,'~ ~ PHONE SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER __ INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY GALLONS. TILE DRAIN FIELD:~ DISTANCE [:ROM WELLIng-) ["~-FOUNDATION ~ of Lines 'J DISTANCE BETWEEN LINES ~BSORPTION AREA__ DEPTN: TOP OF TILE TO FINISH GRADE NEAREST LOT LINE /.~ [ TOTAL LENGTH ,OF LINE - -'(~ / ~'~kJ//t~k- TRENCH WIDTH~¢O IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE ~ DEPTH OF FILTER ~.~ MATERIAL BENEATH TILE__ ~'~-~--IN. ABOVE TILE SEEPAGE Pl']': Log Crib Rings BUILDING FOUNDATION__ DIAMETER -- OR WIDTH ., LENGTH DEPTH Crib Size:i DIAMETER___DEPTH_ DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE__ ABSORPTION AREA (WALL AREA) SQ. FT. Well ~~ Class: Depth: Well Distance To: Lot Line Bldg: Sewer'Line: Pipe Materials: ~ of Bedrooms: ~r Installer: ~%C~ Remarks: ~2J) DATE.~APPROV ED LI:ZI3FIL /E) :3 D. ;E';:";: 64 .:.:~: G/ ;-.'~.~.~b~vl .:, .:. J- KI:: FEET I'¢F'E OF z,_ 1L. IL_ .JL.L I 1UN ........ IEtl .I .... TI.,~:IENE:I4 f'll::l',:-:;IMUf'i NLII'dE:EF.: CtF E:EC, D:OOf'IS := ,4. _,U.[I_ F;tFYI"ING ,"::':' F:T/Ed;;:::,= Z:6L::.' I'HE i';tEg!LtlF~E£C, :;Z;ZE OF; ' : ':: I HE ....IjIL HE,=,uKF I .JuN .:,.r.::, I El1 ]HIE LENG'i'H DIIdENStON IS 'THE LENGTH (IN FEET') OF' "i-HE TI4'.ENCH OR: [::,RRINF~EL.[h 'I-HE DEI::>YH O1': F:I 'I'F(:ENCH .OR PIT IS ]'HE: DISTRNCE BETWEEN THE SURFFICE OF:' 'IHE GROUND RND 'THE BO-I'-I'OH OF THE EXCR'v'RT~C~N (IN FEET). 'I'HEI'~tE Z% NO SE"I' 1.4Z[:'TH FOR TF;?.ENCHES. THE GI;?.R'v'EL I:)EF'TH ~S THE MINIIYR.IM DEF'TH OF' ~3R'.RVEL BETWE:EI"4 THE OUTF:FILL_ RN[:' ']HE Eu.)TTEIM OF 'THE EXCR',/RTZON (~[N FEET). FOL. LOW ~ NC~ CONt::,I T Z ONS: t. EZTI.-IF;I~ FI CLFISS Z OR IZ NSF' FIF'F:'ROVED F'LRNT I"~RY BE ~N51FILLE[:,. 2. R CONTZNUOUS I"IFttNTENF4NCE FIGREEMENT ZS REQUZI~:EI::,. ZF R MRZNTENFINE:E FIGI;~EEf"IEN]' IS NOT KEPT CLIR']:~'.ENT "r'00 MFP'r' BE R'.EQUZb?.E[:' TO ENL. FIi~%E THE SOIL. FIBSOR'.F:'T;[ON S"r'E;'I-EH RND/OR 'YOU HR'Y DE SODJECT ']'0 F'I4:OSEC:UTZON. c, I_.l...I .[LLIN..~ OF' RN"r' -, -,lEt1 HZTHCIi. JT F:'INRL IN-I'LL..I iLIN AND PFFt.-,Ht. THIS [:'L:EF'Rb?TMEN'I- WIL. L Eft::.: :,L.Ib,.]l:_.'f TO 1'6-:,E_.L.tt 1UN. HINIHUP'I [:'IS"I'RNCE DE'TWEEN R HELL. FIND RN'¢ ON-SI'T'E '-:;EI.,IRGE DISF'OSI:~L S','S'TEH IS iOO FrEE-I' FOR FI F'Dt:[VRTE HE]....L. OF;;'. 200 FEET FOR R F'UBL. ZC WEL. L. OTHEI(', [~:EiQLIIF;;:EHENT% 1'4F:1¥ RF'PL'¢. SPECIF'ICFtTIONS RND CONS-FRUC:TION DtRGI~:FIHS FIRE R',,,'RILRE~L_E: TO INSURE PROF'E:R INST'RLLRTION. i E:E:F~tT:[F'¢ THIqT FOI':.:I'I"t B"'r~ THE IvtUNICI[::'FILIT~¢ OF:' F:INC:HOF'.RGE. :.~: :( WILl_ ZNS'I"flL. L. THE S"r'S'I"E:I'"t IN RCCOI;?.DRNCE WiTH THE CODES. I~:: ~ UNDEb?.%TRND THRT THE ON-SITE '.::;E!.4EF;:~ S'T'STEM f~F'F'L I C:FINT Dl~ HtTH 'I'HE F:E:(.:.!UIREHENT'.'5 FOF': [;IN-SITE: ._,EHER.., RN[:, WELLSI I'Z': ...... ':':'ET ENI_F:IF;b3E:HENT t I::' 'T'HE k,']i:. 0 ~GR[~,;E R~ ANCHORAGE AREA BO~..,UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM '- SEPTIC TANK: '% D,STANCE /O// FROM WELL MANUFACTURER INSIDE LENGTH NUMBEROF / MATERIAL COMPARTMENTS INSIDE WIDTH '-'-"-~ LIQUID DEPTH ~ LIQUID CAPACITY/2~.~ GALLONS· DIAMETER OR WIDTH LENGTH DEPTH DEPTH¢ ¢ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SD, FT, SEEPAGE Pit: NUMBER OF PITS / CRfB SIZE: DIAMETER BUILDING FOUNDATION NEAREST LOT LINE ~0¢~. ADDITIONAL ABSORPTION WELL: TYPE,. ¢,/~ ~/',~, BUILDING FOUNDATION CESSPOOC~ APPROVED CONSTRUCTION X/~_'//J NEAREST 2 7~I NEAREST LOT LINE SEWER LINE OTHER SOURCES DISTANCE FROM: DISAPPROVED REMARKS TANK SEEPAGE SYSTEM d Form No. EQ-031 DIAGRAM OF SYSTEM pr'7~ ./ G,A,A,B, I~__ / ~ GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE~A~L~i~K~A 99503 TELEPHONE 274-4561 PERMIT NO, SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAMe OF APPLICANT /~/~F ~/'/'~-/~J~)E/'~- MAILING ADDRESS PHONE INSTALLATION OF: SEPTIC TANK ~ SEEPAGE Pit ~ , DRAIN FIELD FINANCED THROUGH ~o,~ TEST RESULTS P~ ....... COMPLETION DATE ANTICIPATED NOTE: THIS PERMIT IS HOT VALID WITHOUT SOIL FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WiLL BE SUBJECT TO PROSECUTION, SEPTIC TANk SIZE / ~-3~ TYPE SEEPAge AREA SIZE TYPE FOUNDATION TO SEEPAGE PIT '""z'L'/ DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL J"~'/ WELL TO SEPTIC TANK -- ~*/ / SEEPAGE PIt / ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK. DRAIN FIELD SEPTIC TANK, ~ / -, SEEPAGE PIT TO RIVER, LAKE. STREAM. · SEEPAGE PIT ~Jr~/ DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVAT]ON 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. CONFORM TO ~:~OROUGH REGULATIONS REGARDING INSTALLATION. DIAGRAM OF SYSTEM CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM iS IN ACCORDANCE WITH SAID CODE. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAl QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For ~ W. Legal Description: Lot This Form Reports Soils Log~ - Soil Test Must Be Logged To 4' Depth Feet Soil Characteristics ~S:~$ ¢~r¢-~-v Dated Performed ~-I~- Block ! Subdivision T~o~ ~_. Percolation Test 4~ eo~ ]~Is ~round ~ater Encoun~eved?~/vO Below Proposed F If Yes, At What Depth? Seepage System - T Reading Date ,~. Gross Time Net Time i Depth to H20 Net Oro , ....... ! ...............' I . Percolation Rate Min .'ce Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom '~Pit Or Trench Test Performed BY ...... UH CJRAL JY OF HCH0RAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-201-32-000 Expiration Date: 7/20/2023 Legal description TALUS WEST Lot/Block: BLK 1 LT 9 Site address 11915 WILDERNESS DR Anchorage AK 99516 Current property owner(s) EDWARDSEN BOBBYJO X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: =I Original Certificate Date: 4/20/2023 This 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 ApprovaLJune 2022 MUNICIPALITY OF ANCHORAGE :(t �sr 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. 015-201-32 Complete legal description TALUS WEST BLK 1 LT 9 Location (site address) 11915 WILDERNESS DR„ ANCH AK Current property owner(s) EDWARDSEN 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 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: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: [M Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age new - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑■ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ 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 $ '� S-5(:) Waiver Fee $ Date of Payment 41117 /'L4'Z 3 Date of Payment COSA # O SC 2 3( O 92 Waiver # COSA Application—June 2022 COSA Checklist Legal Description: TALUS WEST BLK 1 LT 9 Parcel ID: 015-201-32 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled UN Total depth '96 ft Cased to •40+ ft ❑ Sanitary seal is functioning correctly IN Wires are properly protected Casing height (above ground) 16 in. Date of flow test for COSA 4/14/23 Well production at time of test 5+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes X No X Coliform bacteria is Negative Nitrate 1.52 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by MINA Static water level at beginning of test 84 ft. Date 4/4 & 18/23 Comments 'WELL TOTAL DEPTH AND CASING DEPTH TAKEN FROM COSA 181002 B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: NEW STEEL TANK INSTALLED D. ABSORPTION FIELD DATA Which system tested (date installed) 6/22/90 FE� ALL standpipes present per record drawing Total measured depth from grade 2.7 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A —pressurized field. 01 Per record drawings, field is insulated. ❑N Monitor tubes go to bottom of effective. If not, state depth into effective Q Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 3000 gallons 4/14/23 date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 C. LIFT STATION ❑ Required maintenance completed Age of lift station 2023 years Lift station material steel Comments: new tank installed Adequacy test date 4/14/23 Results [j]Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 3 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Ri Yes if No _ ft [K Yes if No _ ft Neighboring Tank > 100' Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Absorption Field on Lot > 100' Yes if No _ ft Holding Tank > 100'❑ Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No _ ft Qi Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑e Yes if No _ ft []i Yes if No _ ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑� Yes if No _ ft Surface Water > 100' R Yes if No _ ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' Mo Yes ifNo_ft ❑� Yes if No _ ft ❑- Yes if No _ ft E Yes if No _ ft F. ENGINEER'S COMMENTS * ADEC WAIVER 2014 Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' a] Yes if No _ ft ❑ Yes if No '150 ft If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm N4 he— /�Kd.rvj-01- R �. Phone 727-8864 Engineer's Printed Name S G w-. �� Date COSA Checklist June 2022 • • ,i.4_ 36 • Municipality of Anchorage :, On-Site Water and Wastewater Program , .,. • (907) 343-7904 S [T.r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-201-32 Expiration Date: q- 2- 1 0 1. GENERAL INFORMATION • Complete legal description TALUS WEST BLOCK 1, LOT 9 Location (site address) 11915 WILDERNESS DRIVE,ANCHORAGE,AK 99516 Current Property owner(s) BRUCE WESTON & EMILY ANNE SMITH Day phone Mailing address 11915 WILDERNESS DRIVE, ANCHORAGE,AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) Duplex (l Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual El Individual Well ® Holding Tank Individual Water Storage C Community Community Class Well H Public Sewer n Public Water System WaiverNariance request for: Distance: Received by: ... 47"-- 4e#- Date: l�r/(0 COSA to be released to the engineer, ise requested by the engineer. COSA Fee $ ,5--- 1.., Waiver Fee $ Date of Payment 1/3// S Date of Payment Receipt Number 07l D Receipt Number COSA# 656I 5?l 009- Waiver# 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, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 12/20/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen � \ encroachments,deficiencies or discrepancies exist. OF Az Rs Af . v 6. DSD SIGNATURE System #1 Approved for bedrooms. ` r`' KENN 11 N11. DUFF, System#2 Approved for bedrooms. 1� �� 711s 1 C• .�u Disapproved. ''`�+;Szt.IAN ' Conditional approval for bedrooms, with the following stipulations: I Vl c:S C i G �'�t.Ic (� a el.vS OLD " J1& I ( v 0v Ct c% € 4- 4 _ t 2aectA;.,, , ON-SITE WATER AND 51-^ ASTEWnT n z=, PROGRAM ,: � F � VS Y "�^ Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doe If more than 1 septic system is on the lot: COSA Checklist# of_ Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: TALUS WEST BLOCK 1, LOT 9 Parcel ID: 015.201.32 A. WELL DATA—(PER MOA RECORDS&TESTING OBSERVATIONS.) Well type PRVT If A, B, or C provide PWSID# Well Log (Y/N) N Date completed unknown Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 96+ ft. Cased to 40+ ft. Casing height(above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test -- 10/12/2017 Static water level •• ft. 85 ft. Well production -• g.p.m. 6.2 g.p.m. WATER SAMPLE RESULTS: Coliform NECr colonies/100 mL Nitrate 1. 13 mg/L Arsenic: ND ug/L Date of sample: 12/20/2017 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/STEEL Date installed 5/26/1989 Tank size 1500 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) Y Date of pumping 10/12/2017 Pumper ONE STOP C. ABSORPTION FIELD DATA - N MT extends 1.13'below invert—elevations taken and corresponds wl 2014 COSA docs. Date installed 6/22/1990 Soil rating (g.p.d./ft2 or ft2/bdrm) 250 System type MOUND Length 50 ft. Width 30 ft. Gravel below pipe 0.5 ft. Total depth 2.7 ft. (Measured 10/12/17) Eff. absorption area 1500 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/12/2017 Results(Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 6 in. Water added 620 gal. New depth 7.5 in. (5.5"below lat.) Elapsed Time: 1260 min. Final fluid depth 4.5 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed 6/22/1990 Size in gallons 1500 Manhole/Access (Y/N) Y "Pump on" level at 33 in. "Pump off' level at 33 in. High water alarm level at 38 in. Datum BOTTOM OF TANK Cycles tested 2 Meets alarm&circuit requirements?Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 95'+(2014 Waiver) On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway,parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) 15'to Foundation Drain-2014 Waiver Wells on adjacent lots 100'+ F. COMMENTS Similar conditions found as described in the 2014 COSA docs based on observations and elevation measurements during the testing process. The STEP tank is 27+years old and approaching the end of its useful life. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. �i`� Ar <Sy 1 4� Engineer's Printed Name KENNETH M.DUFFUS Date 12/20/17 ,0' ,1"--)A 9TH * r4 T-. 4'I COSA canary sheet_2-6-15.doc N`������ r 11,x KENNETH M. l tir 71 \p ' 1 a'� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAIrTH & 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. # O{S"- ~°1 '-.-~7_~ HAA # 1. GENERAL INFORMATION Complete legal description Lot 9; Block I; Talus West Subdivision Location (site address or directions) Property owner Mailing address Chuck Driver 11915 Wilderness I1915 Wilderness Drive Anchora~e~ AK Day phone 264-2220 (w) 345-6454 (h) D~ive Anchorage, AK 99516 Lending agency Mailing address. Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 4 Individual well XX× Community well Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 inves_ti_gation 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 Phone DHHS SIGNATURE Approved for /~ Disapproved. Conditional approval for bedrooms. Date ,~///2~/~- ~ bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Sen4ces (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. MUnicipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT ~r /'J'u,( / 'T-~t.u-~ f/J~7-~/~ Parcel I.D. A. Well Data Well type ~/,ud~d.~ /~/¥'"~(.h"lf A, B, or C, attach ADEC letter. ADEC water system number Log present (Y,{~ /we Date completed N,t~Q. Driller Total depth ~¢%", Cased to ~.~c..3/'~ Casing height Sanitary seal (~1) ~'/~ Wires properly protected ~N) FROM WELL LOG AT INSPECTION Date of test /~ /~EL6_ L_o(. ~/1~/~3 Static water level Well flow .g.p.m. ~,, n° g.p.m~ Pump level1 ~u,~ /~o r SEPARATION DISTANCES FROM WELL TO: Septic/,~tank on lot /()0 Absorption field on lot /00 Public sewer main /C~/JC'- Sewer service line ~.~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (~//~©~/~ ,- Date Of sample: OC~/-~E / ~ Nitrate (],.~/~ //~'z.)-'/..~ Other bacteria Collected by: B. SEPTIC/NCL3'.:.'~ TANK DATA Date installed ~' / ~ / ~ Cleanout (s~) High water alarm (Y~J~ ~ Date of pumping Tank size /~'-E;z~ ~/4f-~ Compartments Foundation cleanout Y~.~) ~(,$ Depression (Y~ Alarm tested (Y/N) Pumper ~4- /~O/4d~-- SEPARATION DISTANCES FROM SEPTIC~TANK TO: Well(s) on lot /(-~)© ! ¢" On adjacent lots To property line 4¢-O/-¢- Absorption field Sudace water/drainage /V~, ,~E" ~FC~;'L%U7-- /~0 /~ Foundation // /0 '¢- Water main/service line 72-026 (8/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~- 7~-- ;¢~ Size in gallons /.~-¢D o 4~/3 (-- Vent (Y~_~ /of~ "Pump on" level at High water alarm revel ~Lo/' Meets MOA electrical codes Y(~) (//~-~- Manufacturer ,,~/~CHo,"L~q~ Manhole/Access (~'~) // "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Wellonlot [(X')~'/- On adjacent lots / O0 6/_ Sudace water D. ABSORPTION FIELD DATA Date installed ~o - Z_ 'Z_ - c;/O Soil rating (GPD/Ft Length .~(~ r Width ..~ O · Gravel thickness o. Total absorption area __/_~('~O Z~ Cleanout present,N) Date of adequacy test ~//o / ~-.~' Results ~il) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) After test /0o.,t~,~'- ,/'~'AJ0Ca,,._./ If yes, give date ./('//./J' System type ~-¢~.~0 Total depth q'¢, Depression over field (Y~. for z¢_ / ~O ~F~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /('~() r../:~ On adjacent lots /~0 /'7° Property line To building foundation /O ~ To existing or abandoned system on lot ~ On adjacent lots ~¢/~ Cutbank ~ ]~ ~J¢~Water malmsey[ce line Sudace water ~ ~ ~ ~ JE~ Driveway. parkinCvehicle storage area /~ ¢~ Cudaindrain ~ ~-~ E. ENGINEER'S CERTIFICATION Signature/certify that I ha vest,checked, verified conformed/to ii MOA and HAA Engineer's N,a'r~ Date ~Eao~., e / HAA Fee $ Date of Payment Receipt Number guidelines in effect on. ~ of this inspecbbn. Waiver Fee $ Date of Payment Receipt Number ,,~ COMMERCIAL TESTING & ENGINEERING CO. ~I~AL LABORATORY SERVICES REPORT of ANALYSIS Chemlab Ref.~ :93.3885-3 Client SamDle ID :L9 BLK ! TALUE WEST S/D Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :S & S ENGINEERING Ordered By :SCOTT SWENOR Project Name : Project~ : PWSID :UA Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S.S. WORK Order :69157 Report Completed :08/10/93 Collected :08/05/93 @ 09:40 hrs. Received :08/05/93 @ 10:15 hrs. Technical Director:STEPHEN C. EDE Released By : ~ ~.~ QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 0.31 mg/L EPA 353.2/300.0 10 08/05 LLH See Special Instructions Above UA = Unavailable See Sample Remarks Above NA = Not Analyzed Undetected, Reported value is the practical quantification limit. LT = Less Than Secondary dilution. GT = Greater Than ~SSS Member of the SG$ Gro.p (Soci~t~ G~n~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA 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. # ~'-'~ \~-~- 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision section, township, range) Lot 9~ Block Ii Talu~ W~st Subdivision Location (address or. directions) (b) Property owner Mailing Address (c) Lending Institution F'.N~M.A. 3201. C Street , Telephone: (home) Anchorage, Ak. 99503 Business Mailing Address Telephone (d) Real Estate Company and Agent JACK WHITE COMPANY ATTN: (e) Address 5201 C S~¢~ S¢¢J~ 100: an¢bn~g¢: Ah. 99503 Telephone 565-5500 Mailthe HAA~othefollowing address:(oroheok here[~ifhoJdforpiok up.) Listcontactgerson and day phone numberbelow: $ & $ ENGINEERING Eagle River~ Alaska ~9577 2. TYPE OF RESIDENCE Single-Family ~,'( Number of bedrooms 4 3: WATER SUPPLY Individual Well E~x- Community [] Public [] Note: If community well system, must have written confirmation from Conservation. attesting to th legality and status. the State Department of Environmental 4. SEWAGE DISPOSAL On-site (~Y- Public [] Community [] Holding Tank [] Note: If'community well system, must have written confirmation from the State Department of En~i'r~tme~tal Conservatic ~ attesting to the legality and'status. ' ..... '" ' . '· 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATIO~I ~ As certified ey my seal affixed hereto and as of the validation date shown below, I verify' that my investigation of this Health Authority Appro,~al shows that the on-site water supply and/or wastewatm' disposal system is safe, functional and adeo uate 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 ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm · Telephone (.~-~' S & S ENGINEERING . . Address 17034 Eagle River Leop Road N~, ')04 :'" ' E agleRiver, Alaska99577 ,-' Date 6. DHHS APPROVAL Approved for[ ¢ ' ~%/~'(~J~"Oisa p p roved Approved Terms of'C6nditional Approval bedrooms by Z~~i Conditional 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. 72 025 (Rev. 7/88) Back Page 2 of 2 A. WE' £;ATA RECEIVED Well ClasSification ~,'r~,l~ ~-~/vt'iJ~ Well Log Presedt (Y/N) ~_ Date Completed (.)~ Total Depth ,Dk~_ Cased to ~O~ Depth of Grouting ~, MUNICIPALITY OF ANCHORAGE (MOA) ,.,, ^,,~.~,~J:~ Authority Approval (HAA) .L~t~:~_ :~/ i~:~LIST - FEBRUARY 1984 ENViP~(~'AL SERVICES ~' ,O 343 4744 ' JUN 2 9 1990 Legal Description: / Static Water Level 9/"/ / Casing Height Above Ground ! ~-- ~' Jr- Electrical Wiring in Conduit (Y/N) ~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / (20 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line __ ^I/~ To Nearest Sewer Service Line on Lot If A, B, C, D.E.C. Approved (Y/N) (b- Yield Pump Set At t..J Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Water Sample Collected by Water Sample Test Results ; On Adjoining Lots · / CO "'/' , On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~,~2.- ~¢/Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) / Holding Tank High-Water Alarm (Y/N) /~"~0~1 No. of Compartments .~.' Air-tight Caps (Y/N) c/ Foundation Cleanout (Y/N) /J Date Last Pumped ~--'~ 2. c~ _ ~ O ~)//R, ;for / Temporary Holding Tank Permit (Y/N) ~/~ To Water-Supply Well To Property Line 'To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~-~ ~ .?i'c. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: (f')¢') '/' To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Width of Field 20 Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well 'fr'/~d'~ Type of System Design Length of Field Depth of Field ~0, Gravel Bed Thickness (~. ~ Statndpipes Present (Y/N) Date of Last Adequacy Test _ To Property Line ~ ¢ /4- To Building Foundation Lot To Water Main/Service Line To Existing or Abandoned System on ; On Adjoining Lots 3o '"~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parldng Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm_.~vel at/~X Tested for ~/~ Meets MOA Electrical Codesl~N) Comments ~-- F~ Dimensions / ;~'~D ~'/~Z.-, ___ Manhole/Access {~N) 7 "Pump Off" Level at Vent d~:'/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. ~ ¢, S ENGINEERING 17034 Eagle River Loop Read No. 204[ Ea~le J~iverz Aj~s~ 9~57/ , Receipt No. ¢"~ ~ ¢0 ,'~/~,'~Z Date of Payment Amount: $ 72 026 (Rev 7/88) Back Receipt Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA99518 · TELEPHONE (907)562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE Eot Work Order ~ 22682 Date Report Printed: JUN 26 90 ~ 09:00 Client Sample ID:L9 BL TALUS WEST PWEID :UA Collected JUN 21 90 @ 19:00 h~s. Received JUN 22 98 Presex¥od with :AS REQUIRED Client Name : S & S ENGR Client Acer : SNSENGP P.O,# NONE RECEIVED Req { Ordered By : R. SHARER Analysis Completed :JUN 25 90 Send Reports to: Laboratory Supervisor :STE~WEN C. EDR 1)S ~ S RNGR Nelea,ed By : //~~ 2) Special Instruct: Chemlab Roi {: 902019 Lab Smpl ID: I ~atrix: WATER Allowable Parameter Tested Result Un, ts Nethod Limits NITRATE-N 0.23 mR/1 EPA 353.2 10 S~mple ROUTINE SAi4PLE. Remarks: SAMPLE COLLECIED BY R,R. I Tests Performed ' See Special Instructions Above UA:Unavailable ND~ None Detected '* See Sample Remarks Above NA~ NotAmalyzed LTmLess Than, GY=Greate~ Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES D,v,s,o. OF ENV, RO.ME.TAL SERV,CES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ~ I"~l I~'~' GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include tot, block, subdivision, section, township, range) Locati6n (address or directions) (b) Property Owner ~/ ~NG~ Telephone:Home ~-~3~O Mailing Address II ~ 1 ~ ~ I~N~ ~ ~ ~ (c) Lending Institution A~ ~o~ ~ Telephone Mailing Address I ~ ~ ~ ~{ (d) Real Estate Company and Agent ~ O ~ ~ Business ~.,..C, 8-- 7(¢ ¢ C) Address Telephone (e) Mail the HAA to the followino address: or: Check here,J~ if hold for pick up. List contact person and day phone number below. . TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Well~r~ Community [] 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 [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/86~ Front 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 ~ealth 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. '~', -~4~~''~ Telephone Nameo{ Firm' Address I . ~,0 '~ t~ Date ~ /'7; DHHS APPROVAL for '"'"'~""~ ~'¢~.~edrooms by ~ ~* ~~ Date /~-- ~ ~ G Approved Approved Disapproved Conditional ~ Terms of Conditional Approval ~ ~ ~ ~ ~,~ '~ CAUTION The Municiparity of Anchorage Department of Health and Human Services (DHHS) issues Health Author~it~, Approval certificates based only upon the representations given ir) paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-o2s IRev 8/86) Back .~ ~,\O~ MUNICIPALITY OF ANCHORAGE (MOA) O4 ~'~.~ -' HEALTH AUTHORITY APPROVAL (HAA) ~ ._~'~ _cc CHECKLIST - FEBRUARY 1984 · WELL DATA '~ Well Classification ~ ~ ~ if A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) NO Date Completed ~~ Yield Total Depth _ ~ I0 ~ Cased to_ ~ I ~ ~ Depth of Grouting I~ ~ ~ ~ Static Water Level ~ Pump Set At ~ /O Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Sanitary Seal on Casing (Y/N) ~-'~,P Depression Around Wellhead (Y/N) ~ ; On Adjoining Lots ,~ ~'~'~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line _ ~ 0/NI ~. Cleanout/Manhole Water Sample CoLlected by _- Water Sample Test Results _ Comments ~¢.¢'~ ; On Adjoining Lots To Nearest Public Sewer N. O N ~., To Nearest Sewer Service Line on Lot "~ _~ .. ;Date B. SEPTIC/HOLDING TANK DATA Date Installed ! ~ ~ 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: To Water-Supply Well _ ~;1~. ~. To Property Line '~ TO Water Main/Service Line Course . Size /,~-*~' ~) No. of Compartments ~ Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) Date Last Pumped i~./"~, ;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 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ,,~(,, Date Installed .~,~-~'~=' /f 77 Width of Field ..,.~ ~1 Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~> /0 ~:~ To Building Foundation ~ ¢,~ D Lot ~ ~ ~ Date of Lest Adequacy Test To Water Main/Service Line ~ '~ O To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design _ Length of Field ~ ~) Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~) TO Cutbank (if present) D. LIFT STATION ~"~ 0 /k//E 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, o~¢~o n for med to all .MO,C, and HAA guidelines in effect on the date of this inspection. Signed ~""~ ~ Date Company MOA No. Receipt No. _ / Date of Payment Amount: $ Page 2 of 2 Engineer's Seal Anchorage P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES December 23, 1986 Tobben Spurkland,-.~oE. 203 W. 15th Avenue,"C" Suite 203 Anchorage, Alaska 99501 S~bject: Lot 9 Block 1 Talus West Subdivision Waive~ Req~/est WR86-175 Dear Mr. Spurkland: A waiver is not required for the existing 92 foot separation between the septic tank and well on the subject property. As you have stated in your letter, this distance was in compliance with State and Municipal regulations at the time of installation in July of 1973. The owner of the property intends to upgrade the failed septic system on the property. As a condition of the permit to upgrade the absorption field, an inspection of the septic tank must be performed to verify the integrity of the tank and the inlet and outlet couplings. If leakage or significant corrosion is evident, the tank must be replaced. Your request for a waiver will be reconsidered for the new tank at that time if necessary. Sincerely, civil Engineer On-site Services ~ ~"~,--~ ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOT 9, BLOCK 1, TALUS WEST LOCATION: 11915 WILDERNESS DRIVE OWNER .- DAVID & LINDA CLONINGER RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS WELL .' PRIVATE, ON SITE SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, ONE COMP. 1250 GAL. ABSORPTION SYSTEM: TRENCH AND CONCRETE CRIB ABSORPTION AREA: 960 SQ. FT. SOIL RATING: 262 INSTALLATION DATE: 1973 & 1977 DATE OF PUMPING: DATE OF TEST: DECEMBER 16, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH FOR FEET OF COVER AND A LIQUID DEPTH OF 49 INCHES. PIT WAS MORE THAN 12 FEET DEEP AND FULL OF WATER. 250 GALLONS OF CLEAN WATER WAS ADDED TO THE SYSTEM WHILE THE WATER LEVELS IN THE TANK AND CRIB WERE MONITORED. THE CRIB LEVEL ROSE 9.25 INCHES AND THE LEVEL IUN THE TANK ROSE 5.5 INCHES. THE WATER LEVELS WERE MONITORED FOR 40 MINUTES, DURING WHICH TIME NO DROPP WAS NOTICED. NEXT DAY THE LEVELS WERE CHECKED AGAIN AT 12:30. TANK DEPTH WAS FOUND AT 56.5 INCHES. TEST RESULT: THIS SYSTEM DOES OF THE MUNICIPALITY OF ANCHORAGE. TO MEET THOSE REQUIREMENTS. NOT MEET THE CODE REQUIREMENTS THE SYSTEM MUST BE UPGRADED 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. ~... , , , ~ ~,) ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279 3916 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: LOT 9, BLOCK 1, TALUS WEST 11915 WILDERNESS DRIVE OWNER: DAVID B. & JUDY CLONINGER TYPE OF WELL: WELL LOG AVAILABLE: SINGLE FAMILY NO INSTALLATION REQUIREMENTS MET: NO. WELL CAPPED WITH CAP, NO SANITARY SEAL. WELL 92 FEET AWAY FROM SEPTIC TANK. PUMP YIELD: 6.5 GALLONS PER MINUTE DATE OF INSPECTION: DECEMBER 16, 1986 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6.5 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT 86 FEET BELOW TOP OF CASING. WATER LEVEL STABILIZED AT 104 FEET AFTER 25 MINUTES OF PUMPING. WELL WAS PUMPED FOR A TOTAL TIME OF 40 MINUTES. WELL RECOVERED 90% IN 10 MINUTES. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON DECEMBER 17, 1986. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. 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. ~ ~ [~ ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279 3916 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 6-6650 ANCHORAGE, ALASKA 99501 DECEMBER 19, 1986 SUBJECT: REQUEST FOR WAIVER OF SEPARATION DISTANCES FOR PRIVATE WELL. LOT 9, BLOCK 1, TALUS WEST Gentlemen; We are submitting a request for waivers from the separation distances stated in Title 18, Alaska Administrative Code Chapter 80.020 At an Health Authority Inspection on December 12, 1986, the distance between the septic tank and the well was measured to be approximately 92 feet. The well and septic tank are located on opposite sides of the residence and a direct measurement between the two can not be done. When the system was installed in July of 1973, the distance was reported at 101 feet. At that time the required separation distance was 50 feet, so any distance greater than 50 feet was sufficient at that time. Since the well and septic met the current code when installed, a waiver is requested. Yours CONSULTING ENGINEER ~ ~ ~ ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL DECEMBER 19, PROTECTION 1986 Re: Request for Conditional Health Authority Approval Lot 9, Block 1, Talus West Judy Cloninger Gentlemen; On behalf of our client, we request a conditional approval of the septic system serving Lot 9, Block 1 of Talus West. This system was installed as a four bedroom system in 1973 and inspected by Municipal Inspectors at that time. The existing tank is a one compartment Greet Steel tank with a trench and a seepage pit. The Trench was installed in 1977, after a reported failure of the pit. The Municipal inspector noted in 1977 that the soil seemed tighter than the reported rating of 262, which was used to design the required infiltration areas both in 1973 and in 1977. A percolation test was not performed either year. The owner is seeking refinancing of the property, and will escrow funds to upgrade the system this spring. There is no immediate danger for the system to fail or cause a nuisance. Yours MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES )IRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. I, PROPERTY OWNER I PHONE I 349-5775 Don Templin MAILING ADDRESS NHN Wilderness Lane PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE David B. & Judith A. Cloninger 274-9445 MAILING ADORESS 4109 Cope St., Anchoraget Alaska S. LENDING INSTITUTION Alaska Mutual Savings Bank - Ruthanne Overstreet MAi hi NG ADDR ESS P.O. Box 1120~ Anchorage~ Alaska 99510 4. REALTOR/AGENT Bowman Real Estate - Carol Huff PHONE 274-3561 PHONE MAILING ADDRESS 1355 Cresent Ave.~ Anchorage ~ Alaska 5. LEGAL DESCRIPTION Lot 9.~ Block 1, Talus West STREET LOCATION NHN Wilderness Lane 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One ~ Four [] Other [] SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY [~] INDIVI DUAL* * 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.) 8. SEWAGE DISPOSAL SYSTEM iNr~iViDUAL/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} MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & t:NVIRONMENTAL PROTECTION [,:lAY 1 1978 RECEIVED THIS SIDE FOR OFFICIAL USE ONL W'~ ~' ' ~'~'~"? ~ATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECT~ INSPECTOR NSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF B~DROOMS ~SINGLEFAMILY ~ ONE ~ THREE ~ FIVE ~ OTHER ~ MULTIPLE FAMILY ~ TWO ~FOUR ~ SIX PERMIT NUMBER 2. WATEB SUPPLY ~;DIVIDUAL DEPTH OF WELL ~ COMMUNITY DATE DRILLED ~ PUBLIC UTI LITY Connection Verified LOG RECEIVED ~ PERMIT NUMR~R 3~AGE DISPOSAL SYSTEM ~INDIVIDUAL/ON -SITE DATE INSTALLED Co~neotion Verified INSTALLER ~epticTanl<or ~HoldingTank ~ Size: /~,~__ fTan( shomemade SOILS RATING give dimensions; ~ TYPEOFTA K ~ MANUFACTURER TOTAL ~ PTION A~E~O MATERIAL ~O e Nearest~ot) ~ine 4, DISTANCES S~'~ic/Holding Tank Ab WELL TO: /¢ ~ Absorption Aroa to nearest Lot Line ~ CO~DITIO~Ak A~OVAk {letter must accompan~ certificate) ~ DISAPP~OV~B DATE BY (Title) 72-010 (Rev. 3/78) .//~~-; , DEPART~~ OF HEALTH AND ENVIRON~EN~ PROTECTION ~'/ 264-4720 ~pO ~-~ pDS~P Date Received: January 19, 1978 ~1: Time I;',l/Q ~ #2: Time #3: Time Date /-~-~ ~- Date Date Insp ~ Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: United Bank Alaska Mailing Address: 645 G Street 99501 Property Owner: Mailing Address: Legal Description: Don/Linda Templin Phone: 276-1911 Phone: ~05 ~/~&Q. Lot 9 Block 1 Talus West Subdivision Single Family Residence: ~) Multiple Family Residence: ( ) Number of Bedrooms: Four Number of Bedrooms: Well System: Permit # Construction Individual Well ~ ) Community/Public System ( ) Depth of Well Io~' Well Log on File Bacterial Analysis Sewage Disposal System: On-site System ~ Public Utility Permit ~ Installed ~0g~ Septic Tank Size I~ ~e~{..~. Manufacturer ~. Absorp%ion Area q~{O~o.' Soils Rate ~kl~ Material ~Qo~.c~. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 9 Block 1 Talus West Subdivision Comments: Affadavit Attached Approved: '{~ < Disapproved: Letter Attached: ( ) Date: Date: Department Worksheet: llV~ 1UNOIIVNB)INI BOJ ION (e~elsod snl~ ~lO~--llV~ (:]31:11.L~130 aO,:l J.d1303; P MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECT rO,~ 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 REQUF-ST FOP, APPROVAL OF INDIVIDUAL SEWEF~ and WATER FACILITIES 1. Type of Inspection: VA_ ~' . FHA ..... --_~CONV-./J Mailing Address:_ 3. Name of Buyer:. Day Phone: Mailing Address:_ Day Phone:_ Name of Lending Institution: ~,~-~,k~-'~ %~x,&. ~k%%~ Mailing Address:~.-,L~'~"~t:,' ~. ~.~,~ ~_Phone: ~qk-~q~l 5. Name of Realtor or Agent: ~'~'~ Mailing Address: Phone: 7. Type of Facility to be Inspected: 8. Water Supply No. Bdrms. ~ Type of Supply: Public Utility. If Individual, number of dwellings presently sopped If Individual, depth of weli Sewage Disposal System Type of System: RuNic Utility If Individual, date of installation _ / Individual Individual (on-site) 72-003( 3/76) POUCH 6 650 ANCHORAGE, ALASKA 99502 (907) 279 2511 GEORGE ~,~,. SULLIVAN, MA YOR January 26, 1977 United Bank Alaska % Matt Sullivan 645 G Street Anchorage, Alaska 99501 Subject: Lot 9 Block 1 Talus West Subdivision On January 24, and 25, 1977, I ran a percolation test on the subject property. Four-hundred (400) gallons of water were added to the existing pit. After twenty-four (24) hours the water level was measured. The test showed, that the system only got rid of one-hundred fifty (150) gallons of water. A four (4) bedroom home will use an average of six hundred (600) gallons of water a day. In order for this department to give any approval, an upgrade of the sewer system will be necessary. If there are any further questions, this office at 279-2511, extension the offices at the above address. please contact 224, or come by Sincerely, Robert C. Pratt, R.S. Sanitarian RCP/ljh GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "c" Street, Anchorage, Alaska 99503 274-4561 Date Received August 2, 1976 Time Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR voao l. Approval requested bY: United Bank of Alaska % Matt Sullivan Mailing Address: 645 G Street Phone: 278-9526 2. Property Owner: John & Judy Anderson Phone: 349-3758 Mailing Address: 3. Legal Description: Lot 9 Block 1 Talus West Subdivision 4. Location: Wildnerss Drive 5. Type of facility to be inspected Single Family No. of bedrooms 4 Well Data: Individual A. Type B. Depth 67' C. Construction D. Bacterial Analysis Sewage Disposal A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: System: July, 1973 1. Size On-site system B. Installer % .~ ~?Jv~ ',~' ( -')- ~ 2. Manufacturer 1. Absorption Area ~'t%>~,...~-~--2. Material Total length of lines 8. Distances: A. Well to: Septic tank Nearest lot line ~ B. Foundation to septic tank C. Absorption area to nearest lot line , Absorption area Other contamination ~0~ , Absorption area , Sewer Lines EQ-034 (1174) Page 1 of two pages Page'2 of two pages - Req t for Approval of Individual S, r & Water Facilities ,'L~ga~ Desc~ipti0n Lot 9 Block 1 Talus West Subdivision Comments Approved Dis, p proved ~ ~/~ 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 are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES I. Type of Inspection: CMRO VA.~h? .': ~ FHA Mailing .Address: ..... CONV-, ,,,, Mailing Address: Day Phone: _ ./ ;' 4. Name of Lending Institution: /)~,/'/~1" "/'~ ~/ ~¢'~///? ~'" Mailing Address: ~ ~S .... Phone: ¢ < ' " X,-.f.,,.., 5. Nameof Realtoror Agent: ~" ~ '~z // L,. ,r/// Mailing Address: d'7') /~' b['(."[ //~' ' /' 6. Legal Description: X¢ ~ ¢~/0(),'(' / ':/~¢¢ Z'¢)¢¢~;' Type of Facility to be Inspected! Water Supply No. Bdrms. , Type of Supply: Public Utility Individual If Individual, number of dwellings presently served ~/) ~ If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation b?' Public Utility Individual (on-site) !, ., / ..,,? , 72 003(3/76) 3. 4. 5. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, A]aska 9950'7 279-868~ Date Received_ REQUEST FOR APPROVAL OF I~IVIDUAI, SEWER a ~ATER FACILITIES FOR C. Construction D. Sewage Disgosal System: ~~--~. A, Installed C. Septic Tank: 1, D. Seepage P~ E. D~aposal Field: ToLal Lenq~h D~stances: A. C. ~el, TO: Septic Tank //O// / , Absorption Area /E~,'Sewer Lines / Nearest Lot Line , , Other Contamination Foundation to Septic Tank /~.~./ '~ Absorption Area ~ Absorption Area to Nearest Lot Line ~ /~ Pa~ Two .._~ 9, CdmmentS: Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, Decartment of Environmental Quality DIAGRAM OF SYSTEM '~ ~ert] fy that the informat~n contained i/t~s request lo'approVal to be a true and accurate representation of the sub~ect sewer and water facilities located at: Signed Date