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Home My WebLink AboutTALUS WEST BLK 2 LT 2Talus Block #015-201-12 · ' Municipality of,,A.,n.c.h, oragePageI of '~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL'SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: , ~010'0'7~ PIDNumber: O~5"o,0--OJ "' i Na.~e- '---f'~4'~V' ~-~///,5/~0~ Wastewater System: ID New '~Upgrade ,ddress: I/W q ABSORPTION FIELD Lot: ~ Bloc~ r~~Subdiv~l°n:~ ~ Depth to pl~ ~ttom from orlglnal~ grade: FL Gravel depth beneath~ipe Township: I Range: I Section: Fill added above original grade: Gravel length: I I WELL: D New D Upg ra~e era~e~ width: ~ Ft. Number of fines:! I I Distance-between h~es: Yield: GP~ t at: Fi.I~ Casing. Height A~. Ground:FL TANK SEPARATIONDISTANCES ~ septic .~ Holding ~ S.T.E.P. From Tank Field Station Tank Sewer Llnel ~ ~ Well- 7~ IO O > I ~ Material: Number of Compa,ments: SarfaCewater H/O NJ o LIFT STATION LOt Size In gallons: I Manufacturer: Line ~ O t O ~oun~ation Pump Make & U~el I~r,c,, ~nspoctions pe,ormed by: Drain~' ' Remarks: BENCH MARK Locatlon and D;scrlptlon: ~ ENGINEEr'S SEAL Inspections performed bY: Dates: Ist ~ ' '"' ~"" Department of Health and Human Sewices approval , ~::-%:,.~ o,.a;~ ~t,- 72-013 (Rev 9/91) MOA 25 // .6 '~ 9- oo '~' 0£ 64 ~CK~7Z~£o LO6 CRIB TRENCH I I I I As~'vu£O El_ry. I I SEPTIC TANI~ IOI'AL I.~GTH 75 t'7 TOTAL D~'PI'H 10 FT RO~K DEPTH $ FT ROCK ¥0L0~£ ~ CU. YO 3 IOBBEN SPURKLAND P.E. 203 ,; ~STN. AVENUE ANCH. AK. agSO~ (£07),27£-$£I6 LOT 2 BLOCK 2 TALUS ~E'ST PETER HELLSTROM 11~5~ WILDERNESS DRIVE SEPTIC SYSTEM AS BUILT DATE: JUNE 4, 2001 SHEET: 2/3 GRID: 2736 PERHIT # S~'010074 PIp # 015-201-1,2 I'AIv'O2OP2.plvG Standard Trench: 5.0 £t o£ Septic Rock Effective c°' lC~de 75' Lon9 10' Deep 5.0' Sewer rock 5' Cover NO SCALE Monitor ~-- Cleanout 5 Cover / 1cO50 GAL CONCPETE SEPTIC TANK NO SCALE BENCH MARK DOOR Sill TO GARAC~ ASSUMED EIJ~'V. 203 ~J15't:h Ave Anchorage Ak 99501 LOT £ BLOCK £ TALUS PEfER HEtlS[ROt~ I I SEPTIC SYSTEH SCHEHATIC DATE, JUNE ~l, 2001 SHEET, $/$ GRID, cO756 PERMIT ~ SWOfOOT, f PARCEL /D / 015-201-12 TAWO202$.DWG MUNICIPALITY OF ANCHORA GE Deve/opment Services Deparlmen! On-site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Apr 20, 2001 Expiration Date: Apr 20, 2002 Permit Number: SW010074 Legal Description: ITALUS WEST BLK 2 LT ~2 i:: Design Engineer: 0007 Tobben Spurkland, PE Owner Name: PETER HELLSTROM Owner Address: 11959 WILDERNESS DR ANCHORAGE, AK 99516-2240 Parcel ID: 015-201-12 Site Address: 011959 WILDERNESS DR Lot Size: 18000 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ~-~ Disposal Field ~] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. r5:' .The following special prOvision§~ '" . il' 'PRIOR TO CONSTRUCTION OF.THE TRENCH' ABSORPTION'FIELD, THE ENGINEER'SHALL EXCAVATE.TO" ~ ' DETERMINE IF THE CRIB IS BACKFILLED WITH SEWER ROCK AND REPORT BACK TO THIS OFFICE. Received By.' Issued By: Date:, Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Property owner(s) Mailing address (1) Mailing address (2). Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size/8. 000 Acres/'~. Permit Number SW~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Day phone Zip Code ff~516 -Z2.40 Number of Bedrooms [] Well Only [] [--] Water Storage [] I--I Jacuzzi [] I-1 Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Date of Payment: ~/~--'~/~/~ Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 2 BLOCK 2 TALUS WEST S/D PETER ltELLSTROM 11959 WILDERNESS DRIVE Municipality &Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519.-6650 March 26, 2001 We are submitting an application for the replacement of the septic system for this lot. The submittal consists ofthree (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet I/3), the proposed improvements of the lot, &which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests ofapplicable testholes are also enclosed. The septic system design is based on the following: Sewer rock was not used when log crib was installed. By abandoning the existing crib and trench there will be sufficient area to install an advanced system when this proposed trench fails. (in 15- 20 years) No Ground Water or Impervious Layer to 16 ft. Use Standard Trench Soil Rating. From Testhole 3/19/01 10 min/in = 0.8 gal persq.~day No. of Bedrooms 3 Required Area per Bedroom: 150/0.8 = 187.5 sq.ft. Total area required: 187.5 x 3 = 562.5 sqf~ Testhole depth 16 feet Bottom Rock At 10 feet Top Rock At 5 feet Rock Depth 5 feet Total Trench Length 563 / l0 =56 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 75 FT TOTAL WIDTH 2 FT TOTAL DEPTH 10 FT ROCK DEPTH 5 FT COVER 5 FT SEPTIC TANK Check and repair baffles as needed The installation ofthis septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff`will not result from this installation. ~'": '~ .................... ~ ~ i . SCALE, 1'= I00 F~ m~r~ s~u~r~ ~.~. ~0~ ~ ~0~ ~ ~~ ~ srPnc srsr~ ~ES~ 20~ · 15[H. AVENUE ANCH. AK. ~50I PE~E~ flELLS~RO~ DA~E: ~ARCfl 1~, 20DI (907) 279-391G 11959 WI~ERNESS DRIVE SHEET: 1/3 GRID: 2736 PERHIT ~ S~OIXXXX PIB ~ D15-~0I-1~ TAVOBOBI. DWG I I 5 SIR BACKF1LL LOG CRIB TRENCH 6 N 2,5 I' = 50FE j '" SEPTIC TANK TR£NCH TOTAl; LEYGTtt 75 ri' TOTAL D£PIH lO ri' ROCK DgPlY 5 ROCK VOLUM£ $0 CU. YD. DI~(T 3 I TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 (907] 279-3916 LOT 2 BLOCK 2 TALUS PETER MELLSTROM 11959 WILDERNESS DRIVE REST SEPTIC SYSTEId DESIGN DATE: MARCH 2O, 2001 SHEET: 2/3 GRID: 2736 PERMIT # S~/O1XXXX PID # 015-201-12 TA~/O2022,fl~/G O0 0 0 0 o S tondard Trench; 2' IV/de 75' Lon~7 10' Deep ~.0' Se~er rock 5' Cover , NO SCALE Nonlgor C(eonou~s S' Cover 5.0 ~ oP Septic Rock I~SO GAL CONCREE SEPTIC TANK Effec#ve NO SCALE TO~E~ SPU~KL~N~ P,E, ~0~ 2 B~OCK ~03 ~5~h Ave ~chor~ge ~ ~50Z PEER HELLS~RO~ ~' ~ARCH 26, 200~ ~?~-~ ~ ~~ ~ SHEET. S~3 ~. ~736 PER,Ir ~ S~OIXXX PARCEL ID ~ 015-201-12 ~A~O202Z. D~G PERFORMED FOR: Munlcil:allty o! Anchorage DEPARTMENT OF -~EALTH & HUMAN SERVICES 825 "L" Street, Alu'.horage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST LEGAL DESCR,PT,ON: L~T ~. ( ~ V-'2./TALa/s 8 10 12 13' 15 16 17 18 19 20 DISCLAIMFR: flrn.ndwater Past and future presence trom these Gh~ervations. PERFORMED BY; ~~-~ Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES. AT WHAT O DEPTH;) p E SITE PLAN -t- I Depth le Water Alter/ Oale: . eading Net Time Time Water Drop PERCOLATION RATE _(~ (m,nutes/,nch) PERC HOLE DIAMETER ~ TEST RUN BETWEEN ~ FTAND ~ FT conditinns indicated are for the dates shown o.ly. and/or depth of groundwater can not be predictPd ACCORDANCE WITH ALL STATE AND MUNICIPAL GUll ELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY TH/~T THIS TEST WAS PERFORMED IN DATE.' sh lo I GREA,_xR ANCHORAGE AREA BOL ?H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 REPORT ON-SITE SEWAGE DISPOSAL SYSTEM I SEPTIC TANK: INSIDE LENGTH INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQU D CAPAC TY__. GALLONS, DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE ' TRENCH WIDT~ SQ. FT. LENGTH OF EACH LINE '~ / DEPTH OF FILTER MATERIAL BENEATH TILE 7~ IN. ABOVE TILE NUMBER OF LINES / DISTANCE BETWEEN LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE WELL: T Y P E _L z f i,.<r/ , BUILDING FOUNDATION__ CESSPOOL APPROVED CONSTRUCTION DEPTH NEAREST NEAREST SEPTIC SEEPAGE LOT LINE SEWER LINE TANK , SYSTEM OTHER SOURCES DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: SEWER LINE DEPTH: DIAGRAM OF SYSTEM _.//C~[./[..~;REA,...~R ANCHORAGE AREA BOK.. /JGH // ,/ , ~,' DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT TYPE AND SIZE OF FACILITY TO BE SERVED SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED ~'~ ~¢"~'~ ~ q~/~.~O /%~ 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. DIAGRAM OF SYSTEM SEPTIC TANK SIZE TYPE DRAIN FIELD SEPTIC TANK TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD- WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE Pit , DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT SEPTIC TANK, ., seePAGE PIT ., DRAIN FIELD __ TO RIVER, lAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSINg GAP Of EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST iRON SIPHON PIPES ON SEPT~O TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYS,~EM IS IN ACCORDANCE WITH SAID CODE, ~.~ ~--~/~/~? -> . :~'~/~/ '/'~/?' EQ-016(3-75) ~' GREATER ANCHOtd\GE AREA BOROI~,-,./ Department of Environmental Quality 3330 '~C" Street Anchorage, Alaska 99503 S(')II,S I,OG PEROI,ATION TEST Performed for ~.~-.~/~- ~,' - - Legal Descrlpt~ on'~. ~ ~ ~ ~ '~ ~ ~ - This form reports: Soils log. / Percolation lest Depth Feet 14- Was ground water encountered? If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate lln nute. -Proposed installation: Seepage Pit Drain Fie]d Inlet Depth of Performed ~'-~--~5~_._ ~erti fi ed By: ;}ate: ~...' HEALTH DEPARTMENT L.,.~/ 1~'.O 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ADDRESS ,EOA,_ DESCR,PT,ON Z ,////< Z PHONE __ SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY GALLONS· COMPARTMENTS INSIDE LENGTH ? INSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE. '~ ~ SEEPAGE PIT: OUTSIDE DIAMETER OR WIDTH / ~L LENGTH / ~ . DEPTH DISTANCE FROM WELl. BUILDING FOUNDATION . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) Y~/-- ~F' .~.~. -/ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WE L ABSORPTION AREA TOTAL LENGTH .FOUNDATION ., NEAREST LOT UNE . OF LINES DISTANCE ~"~'1~~~E DEPTH: TOP OF TILE TO FINISH GRADE WELL: TYPE" / , DEPTH NEAREST SEPTIC LOT LINE , SEWER LINE ., TANK DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE DISTANCE FROM WATER , BUILDING FOUNDATION SAMPLE , NEAREST SEEPAGE OTHER , SYSTEM , CESSPOOl , SOURCES DISTANCES: i i'9,, DIAGRAM OF SYSTEM / Gr~-A~ER ANCHORAGE AREA BOA~UGH PERMIT NAME OF APPLICANT INSTALLATION OF: ~EPTIC TANK / SEEPAGE PIT FINANCED THROUGH TO BE INSTALLED SOIL TEST RESULTS SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT -, DRAIN FIELD OTHER NOTE= THIS PERMI/T I$ NOT VALID WITHOUT SOIL TEST COM PLETION DATE ANTICIPATED ~C~/~/ FINAL INSPECTION: :24 HOUR NOTIOE RE(~UiREB. SACKFILLINS OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREM~EEI~TS FOUNDATION TO SEPTIC TANK SEPTIC TANK ~/ TO NEAREST LOT LINE. WELL TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT , DRAIN FIELD SEPTIC TANK TO SEEPAge PiT WALL /~ DRAIN FIELD .SEEPAGEP,T DRAIN FIELD , ALSO CONSIDER AREA WELLS. WATER mA~" ~O ~"~ t~NX //~ , SEEPAGE PIT SEPTIC TANK, , SEEPAGE PIT , DRAIN TO RIVER LAKE ~TREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I 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. Depth Feet Soil Ub~A~.~/IENT OF ENVIRONMENTAL 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Performed ~or ) ' o'~ /~ ~ ' ~ · ;. ~.~.~L~'~:__Z~=~~ _Date Performed /a--/~ 7l Legal Description: Lot ~ Block~ Subdivision ~,,,~ ~~/~ s Iorm Reports So~ls~g ~ercola-~on l'es~ Cbaracterist. i.cs ~ t-las Ground t'$ater Encountered?_/1/(~ If Yes, At t/hat Depth? Date Gross Time Net Time Reading Proposed 1 ns taTl~foa: Seepage Del)th Of liilet Depth to [120 Net Drot~ Pit' Draill Field Lc,T I Lorn 1 5 1~oT 5 ,~URV E ¥ TITLE 'Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ' Parcel I.D.- Expiration Date: (~ - ~ "~ - O ~ GENERAL INFORMATION I':ocation (site ?ddress or directions) ~_ ~ q ?-3 q' ~ t L.D ~ IP-. Iq ~-.$~ Current Propefl. y owner(s) ~ ~t~--t ~' Mailing address Lending agency Day phone Mailing address Real Estate Agent ~obb ~ ~'~.~p,c~' I Mailing Address Unless otherwise requested, HAA will be held by •SD for pickup. 2.- NUMBER OF BEDROOMS: ~ phone TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Weli TYPE OF WASTEWATER DISPOSAL: Individual On-site .. ~ Individual Holding tank [] Community On-site [] Public Sewer ~ The Municipality of Anchorage DeveloPment Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water sYstem. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Legal Description: A. WELL DATA Municipality of, An6h°rag , Development Services iDepartment Building Safety D~wslon On-Site Water & Wastewater Program. 4700 South BragawlSL ' i i ', . P.O. Box 196650 Anchorage, AK1199519-6650 ~s . www.ci.anchorage.ak.u. (907) 343-7904' HEALTH AUTHORITY APPROVAL C ECKLIST ~c~'T ~'-i I"~I~.~L, I At-O~ ~'!~,,~ ParcellD: Well type Date completed I,~, Total depth J~/-~ ~ff. If A, B, or C provide PWSID # Sanitary seal (Y/N) Cased to I ~,.,'5't"fl. FROM WELL LOG Date of test' Static water level Well production WATER SAMPLE RESULTS: g.p.m. ~ Well Log (Y/N) Wires properly protected (Y/N) Casing height (above groUnd) 'AT INSPECTION . g.p.m. Coliform colonies/100 mi. Arsenic: mg./L Nitrate . mg./i: Date of sample: Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Tank size ~ gal. Number of Compartments Foundation cleanout (Y/N) lv~5;.al~--Depression over tank (Y/N) A Date of pumping '~'~,~',//~'/ Pumper Date installed Cleanouts (Y/N) ~/ High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed ! . Soil rating (g.p.d./ft2 or ft2/bdrm) C). c~ fl. Width ~, . .' ft. Eft. absorption area ~'~-~ft2 Monitoring tube Fluid depth in absorption field be[ore test ,-~'~. ~n. Wate~;~ 'added,~Dgal. Elapsed Time: j min. Final fluid depth--~--ln. Any rejuvenation treatment (past 12 mo.) (YIN & type) i:,j~ Length 7~" Total depth lO ft. Date of adequacy test colonies/100 System type I dJ~ :' '; - Gravel below pipe i '..~ fL Depression overlfield For .'~ bedrooms New depth ,~.. ~n. Absorption rate >= t. Tt,..'>~ t~ g.P.d. I[ yes, give da!e !, 3-22-04; IGS Ref.#. ~ient Nime ['roject Name~ .'1lent Sample ID /Iatrix. 1041322001 Tobben Sptnkland P.E. · Lot-2, Block 2, Talus West Lot 2, Block 2, Talus West Drinking Water :ampl .e Remarks: ;907 5615301 All Date~l'imes are Alasl~ Standard ~'ime Printed Da{e/Time 0312212004 1f:~7 Collected Date~ime ' 03/17/2004 16:00 ' Reteived D. at_L~ir~ b3./17/2004 16:55 # 3/ 4 .Allowable Prep Analysis · .ramctcr Results PQL . Units Method Container ID Limits Date .Date Init Department Nitrate-N ~crobiolo~y Laboratory 0.100 U ' 0.100 mg/L EPA 300.0 B (<=.10) · . 03/18/04 Total Coliform 0 co.l/100~/, SM18 9222B · A (~=-1) 03/17/04 DPT JIB ~3--22--04; ~5: 35PM; ~:~., ,,.~ ~ q.., ...... ~Drinkipg W~er A~alysis 'Rep0~ for.Total' Coliform Bacteria MUST BE COMP~I~D BY WATER SUP~MER '" ~ PUBm WA~R SYS~ IO~ " ~ s~dkau~a ~n~l~ '" w~~.~:~p,.,' · ·"' '~ .... -,. ' ' i~o ' ~"~:~. -,' ~'.L~ ~..:'.'tY '- .... S~PLE CO~ECTION: SAMP~ ~PE: No~ · ~e:' I ~ ~ ~ PM c~) ~ Repeat S~ple. Co~n:~o~ ~ ~ ~~ ~ ~ (mfer~labno.' to Lab By: ~ Same as ~]le~r Othec / ~E COMpLeteD BY ~O~TORY ' ' ~ample Recolvin~: Date: ·me: . Temp: ' ' aecelv&d B~ ' :~ .. ;907 5615301 ~ 4/ 4 · . 200 W, PO.'[TER DRIVE ANCHORAGE, ALASKA 99518 :,' Tel: 907-562-2343 · Fax: 907-561-530.1 L~Ref No. [] Treated Water · [~Untreated Water ;I RUSH SAMPLE .Bacteriological Water Analysis Record: '." · MM.O-MUG {P/A) RESULTS: Sent to ADEC: D a'le/Tlme:AN..C FBK JUN' I Sent to Clienb. Analytlca~ Method: MEMBRANE FILTER RESUL'rS: IPhcn'ed ~ Faxed J--'l Direct Count: ' (~ Cokxde.~/100ml . JDate/Tlme: [~ Membr~he Filter, Verification: . i~poke~vi~h: · · .. rage: [~ Satisfactory F,~c,,~ { EC:. '.F-i Unsatisfactory · ,~ · : TNTC; · Too Numoce~s to Count Stgnatum .o ~. '. '" I. ' .. · , Form #'FW. 0053 10124/03 . J:\FOR. MS\Micro\Coli Form.xls ,,., · · .i oo WILDERNESS DRIVE 0 0 J i S 89'57'45" E 100.00' I .._.___ '""'"'"'~ g"'""'"'"'" N \: .............. -.~ co ~' .......... ;.".'~,~:;~. BLOCK, I ":':' .~':~~ i '~'' :;':':':':'"' ' , ~ ~ 28.1 ~~. ~~.~ 0 ~ EXISTING HOUSE ~ ~ ~' LOT1 ~ ~~% ~ i LOT 3 LOT 2 I ~ I - I o I I I I I I I ~ I ~<~.. ...... ..~ ~.' ~ '-.~ ~ 10' U.G. Pwr. ~ Tel. Esmts. ~;'~9~~ "~, j ~~ ...~J ........... . s 9. e,oo,,w ~,_ -'.._ LS-lOSg2 .." ,4'~ LOT 15 ........... ~CLU~ON NO~: It ia ~e ownera' respons~lllty to ~ete~Ine LEGEND: SET FND o~ ~ the existence of ~ny ees~ents, covenants, or rea~lctlona 5/8'RB W/C~ 5/B' RB O B OB B I E C A R m EN mE R which do not eppeor on the recorded ~ubdl~slon ple~ NO~ 5.25' ALUON. MONUMENT with PRUDEN~AL JACK ~1~ Under no clrcumatances ~hould any date her~n be ussd for HUB ~ TACK B - - conatmctl~ or f~ estobllshlng prope~y lines. ~- x x ~h~Icol ~u~y of thl~ prope~y es shown on thls ~e BE~S- I I alta*lng end that ~e Impro~ments altuated there-C~m~- on or~ ~It~In the pr~e~y Iln~ end no encroach- A~HALT- i.w:.=v.v:.':.':.vt . manta axial other ~an noted. CRAWL- Ir ¢4-::;_ ;;. I AS--BUILT OF: ~GAL D~IP~ON: SEP~C ST~gPIPES-~ ~ND CONS~UC~ON SUR~YORS-P~NNERS-ENGINEERS WA~ ~- 440 ~ST BENSON BL~. ¢ 10~ (fax) 561-6626 ,.c.o,,~. ,~,s~, ..~o~ (.o~) ~-~ LOT 2. BLOCK 2. ~K ORD~ NUMBS: DA~ ~ ~T ~ SEPT. 24, 20021""50' 71-1~9 ~.~ TALUS WEST SUBDIVISION ~W DUD 2756 565/17 T SPURKLAHD 907 276 203 W~ l~ Fax SEPTIC SYSTEM ADEQUACY TEST, LEGAL: LOCATION: OWNER: RESIDENCE: WET,!.: SEPTIC SYSTEM: Lot 2, Block 2, Talus West 11959 Wilderness Drive Crary and Lorraine Johnson Single Family, Three Bedrooms On Site Single Family FROM MUNICIPAL RECORDS: 3 Bedroom SYstem TANK: 1250 Gal Concrete Tank, One:]Compartments. ABSORFrlON SYSTEM: Standard Trench ABSORPTION AREA: 750 Sq. Ft. SOIL IL~TINO: 0.8 gpdpsf INSTALLATION DATE: May 2001 WAIVERS ORANT~D: None Required DATE OF LAST PUMPING: A+ March 18, 2004 DATE OF TEST: March 17, 2004 TEST PROCEDURE: System was inspected and measured. Tank was found with 3.5 feet of cover and with a liquid level of 70 inches. Trench clean out was fivr fe~ deep and dry. Tren'ch monitor was 10 feet deep and contained no liquid. 520 gallons of clean water were added to the system while the liquid levels in the tank and the trench ~ monitored. The water level in the tank did not change and no water showed up at the end of thc trench indicating that the system was working satisfactory. TEST RESULT: This ~stem meet~ the code requirements of Lhe Health and Social Servic~ Department of the Municipality of Anchorage. NOTE Thc operational life ofall s~fic systtm~ dep~ds on the local soil conditions, groundwuter levels that may fluctuate during the year, and the water usage of the f_ .a~,ily being served by the system. These conditions are outside the control of the evaluator of thisls~tic system. We can therefore not give any estimau: of how long this system will function satisfactorily for cummt or future occupants. All septicsystems ultimately fail. Some systems last 15-20 years, oth~s fall af~ less than five years. MAR--18--2004 01:5~ PM T SPURKLA~ 90? 2T6 601~ P.04 T. SPURKLAND P.E. WEST 15TH. AVENUE SUITE 203 ]:u (907)-276-601~ RESIDENTIAL WELL INSPECTION LEGAL: OWNER: LOCATION: Lot 2, Block 2, Talus West Gay and Lorraine Johnson 1 !~59 Wilderness Drive TYPE OF WELL: Private, Single Family WELL LOG AVAILABLE: No INSTALLATION REQUIREMENTS MET: WAIVERS GRANTED: None WELL YIELD FROM WELL LOG: Gallons per Minute WELL YIELD FROM TEST: NO Weft seal must be replaced 3,$ Gallons per Minute DATE OF INSPECTION: Mm~:h 1% 2004 TEST I'~OCEDURE: Well was pumped mt a constant rate while the drew down was monitored with an acousti~ prose. At the beEinnin~ ofthe test water level wes found at 90 fcct from the top of casing. At a pumpin~ rate of 6.5 gallons per minute the water level dropped down to the pump intake at 125 fcct alter I$ minutes of pumping. At this time the well pmnped 3.5 gallons per mint/te. Thc w~{l wes ptlm~ for atotal of I hour and 36 slams. A total of $20 gallons were delivered. The well recovered to 88 feet at'mr 25 minutes. TEST FOR E.COLI AND TOTAL NITROGEN: Well wes tested for l~.Coli and total niu~gen on October 22, 2001 RESULTS TO FOLLOW RESULTS: i~,Coli 0. Other Bnct~n 0 Total Nitmte-N None Detected, Max. allowable Total Nitrnt~N I 0 mg/l. 10 Colonies of Bacteria Allowed TEST RESULTS: This water quality of this well meets the r,~quircmcnts of the Municipality of Anchorage. __THIS WELL WILL PRoUUCE MOl 3 GAI LONS,P, ER MINUTE FOR,MORE FOrm xOtmS The Municipal requirement for well flaw is 150 i~lons of wats' per bedromn per day. This well exceeds this requirement. Tho assessment of the condition of the well applies only to the conditions as of the tlny tested. The flow nuc may changa due to subsurface conditions ~ may not be observed {','om the surface, anti changes In thc land usc and other factors that may impact thc aquifer feeding thc well. Municipality of Anchorage Development Services Department Building Safety Divisior~ On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7g04 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-~ol- I~- 1. GENERAL INFORMATION Complete legal description LoT Location (site address or directions) Current Property owner(s) ' ~.-~-'¥~- # Expiration Date: ~ ~ - ~,_ O - o '9.__ Mailing address Lending agency Day phone Mailing address Mailing Address ~'~ I Unless otherwise requested, HAA wfll be held by DSD for pickup. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ,,~ Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Se~/ices 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 pdvate or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for proposes served by Class A or B wells or a public water system. The Municipality of Anchcrage 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. I 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. I further verify that based Oil the information obtained from the Municipality of Anchorage flies 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. NameofFirm "'~1.)~,.~,., ?-~u~'l,c-tn~:~ "~- I~.. Address .-.~-.O';~ ~' I~ ~Z~ Enginee~s Printed Name 'i o~. ~u'r~l~.~ DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for Phone }:~?--'7'~ - ~c/i~ bedrooms. Date (~ -/,~-'~ ~-..- -; :..-. ..... ':.: '.. ';..;t .,.,,.... . · oo,;-,o~?., o _. bedrooms, with the following ,tipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X ' Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~-~ - ~ O - ~ ~__ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & ~ter Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ak.us (907) 343-7g04 _O' HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: t_O"['/'~.,~ ~;~'I4,P,~ -~',~1..O'5 A. WELL DATA Date completed Total depth ~' 13I'D ff. If A, B, or C provide PWSID # 'lQ Sanitary seal (Y/N) ~/ . FROM WELL LOG Date of test . Static water level Wall production WATER SAMPLE RESULTS: Coliform _.~colonies/100 mi. Arsenic: v/~ mg./I. B. SEPTIC/HOLDING TANK DATA g.p.m. N firate O,_~d~t~2 mg./I. Date of sample: Tank Tank sizei,-,q- .~.j:2.. gal. Number of Compaq'rights Foundation cleanout (Y/N) ~ Depression over tank (Y/N) Date of pumping .~/1~]ol Pumper J Parcel ID: 01~ -- {~.01-- 12. Wa~ Log (Y/N) ~ Wires probe~ly p~o~=ted (Y/N) ~ Casing height (above ground) ~ C> in. AT INSPECTION ~> g.p.m. Other bacteria ~) colonies/100 mL Date installed Iq I Cleanoute (Y/N) ~/ High water alarm (Y/N) ~"~ ABSORPTION FIELD DATA To= de IO ff. Date of adequacy test Fluid del~ in absorpfian field before test, Elapsed Time: ~"min. Final fluid depth ~in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Soil rating (g.p.d./ft2 or ~/bdrm) ~ System type -T'~-<.~c I~ ff. · Width ~ ft. Gravel below pipe .~ ff. Eft. absorption ama TSD~ Monitoring tube Results(Pass/Fail) - '~ Water added ~al. Absorption rate >= Depression over field ~.~ For ~ bedrooms New depth. ~in. J gp.d. If yes, give date / D. UFT STATION Date installed 'Pump on' level at Datum in. ~ off' level at ~'Cyctes tested E. SEPARATION DISTANCES in. Manhote/Access~) High wa/~.arm level at Me~larm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot Absorption field on lot Public sewer 'main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Absorption field Surface water Building foundation ! O 'l~ Property line ~ Water main t"4/A~ Water service line Wells on adjacent lots ~ q (~ '[-. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I C~ Building foundation Water Sen, ice line '7~ .k Surface water tH Curtain drain ~,1. [ ~ Wells on adjacent lots Water main F. COMMENTS 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 HAA guidelinas in effect on this date. Engineer's Printed Name '-~ ~o ~' ~ .~,~, u, ~;. Date ~-'/~'-- ~) ? HAA Fee $ Driveway, panVJngNehicle storage Date of Payment Receipt Number (Rev. 12/01) Date of Payment Receipt Number irl. Drinking Water Analysis Repo~ for Total Coliform Bacteda RE~ ~3~I~S ON R~RSE 81~ ~FO~ COLLeCtING S~PLE 200W. Po~er Drive A~homge, AK ~18-18~ Tel: (~03) 562.2343 MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED ~Y ~O~TORY ~ pUBLiC WATER ~Y~TEM ~N ...... ~ ~m~e ~er 30 ~m c4d. Resa~ ~y ~ ~ ~ ~sutt~ ~ ~d In~ SAMPLE TYPE: I~ '~.~ Routine Repeat Sample (rarer to lab no. Speclat Purpose L~cat~on C~311ectod from: ~ Treated Water GenttoADEC: A~IC FBK JUN ~ Unt~eatect Water Date: TIm~: , ) ~fient notifloct of uneati~factery r~eu~t~: BACTERiOCOGICAL WATER ANAYSL5 RECORD I_CT&E Environmental Servicea Inc. 9GTSEIS~01 Ct& E Rtr.# 1025948001 Client .~amt Tob'=en SpmkL~nd pl~. P~Ject ~a~ T~us ~e~t ~, ~2 Client Sarape ~ Talus West ~, B2 ~latrlx D~g WI~ Order~ By $~p~e P. emarlo~ All Dltes,'Tlmes are Al~sl~t Stan~ Tlrr~ Printed Date~ime ~/1[~2 12:49 Co~l~ Da~ ~f10.~002 12:~ Re,tided Dat~lme ~/10/2002 13:10 T~bnk~ Dir~tor Slep~en C Kale ~iea:e-N 0.296 PQL 0,200 mg/L EPA3000 I'<'- 101 (Y)I10/OZ J~T Total Ccli fom~ 0 col/10~mL SMl19222n (<-I1 bg!l Cu02 KAP Municipality of Anchorage Development serVices Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 199519-6650 . Www~ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: ~ - / '-~- ~ ~ GI~NERAL INFORMATION Complete legal description 'L"~:~'; O-'i" -~-~'~: .0_.. ' T~.~, LL)L~ ' "U~.~_.,~'~-~. Location(siteaddressordirections) ttq' Cl Current Prope~owner(s) ~~ ~dS~ ~ Day phone Mailing address t t~ ~1¢/~r¢~'¢ ~¢ Lending agency Mailing address Real EState Agent Mailing Address Day phone' " Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: ._~ 5 '~--'~ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class__ Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Cedificates 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 sample results less than 30 days old. (Certificates'may be reissued for a period of up to one year with valid water samples.) Certificates are'valid for one year for 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. MuniciP lity Of AnChorage 'DeveloPment Services Department Building Safety Division~ : On'-Site Wa{er & WasteWater Program · ' ' . 4700 South i . P.O. Boxi196650 Anchorage, AK:99519-6650. !,. , · www:ci.anchorage.ak. US, ! ' ' i!" ', i(907) 343~7904.' HEALTH/AUTHORITY LegalDe;cription:- ~L~i~ ~ ,/'~k ~:l:"tif.~V~'~'~'~ .:.',"": ' 'i ~CellD' 01~--~/-/ A WELL DATA"' " : ' '~' ~ ~ ' ; : ~ "~ . " ' ~pe ~ ~ =; ~ If A,'B?or C )rovide PWSlD ~ r "Well ~og (WN) Well Date completed . . ~ ; .,~ San~ta~eal ~/N)~':. ~'~. .W~res properly protected (Y/N) Totaldepth~l~ ~,'. ', .. ,," Cas~t('~O fl,, :'; ~ .... ~' Casing height (abo~e ground) ~Oin. :' ~. : ':" ' FROM WELL LOGi:;; ' "','="~' ':" ~ ': AT INSPECTION' · i~i, ; ~ , , ,i!,.' , ~,, ', : ! " , '" ' ~ .... ' J' '1 ~, - - ~ ' ~; h, , . colomes/lO0 mi. : N~trate t',~ ~), rog.Ih .:. ~.. Other bacteria ~.~ \'~ colonies/lO0 mi. W, 911 production WATER S ~AMPLE ,.Datb df sample: !, SEP, TIC/HOLDIN I "~,; ' ' 'I' ?~ ': :i" i-!': . ,,." · i !.: ,...i. . ! il, ii ,, . 'Ta~kTYPe,~Materi~ ii i:!,i! '~ DateinSt~lled" !~ /~"7 J Tan~ s~ze', ~ ~ ( ~:',: ~,: ~: Cleanouts (WE)~- ~ ,. Foundabon cleanc ) ,:',~) ~ H ~h water ~la~ IY/N~ Dat~ ofpumpng, 3~'~ ~','~', ~: ~,1.:,' ~ " ,.~.. .... r~r '' ''. ~, ~[; :'. ~ ~1' ',1: , , : Date ~nstalled .~ };:~'~;~ ~ '.. Syste~ty e ~ ~ :LePgth' ~ 7~ ~ ~ , ~,,:fl. :,:,~..,Gra~elo~/p~pe ~ ff. To~l. dept~ /O, ~.'.' ~ff. absor ~bon area ~0 f -Momtorm~ tube, ~ ~i DePression over field Date. of adequa~ test , . ~ ::~.. ~: ::'~ ~. ~ Resu? tss?Fail) ~i.~ "' ~ : :' ': For~ bedrooms Fluid depth ~n abso~bon field be[0retest :' i,..~in ,~::., : :watt, added ~..na ~: I': ' ;' Newa~*h psed~,Time' ~ m~n., : F~nalflu~d depth.~ q~ n. ~ ,: .... ~ Absor~ton ~ate'>= .Any rejuvenation treatment (past 12 mot) (YIN r& ~pe) ~: :',': :~i:'~ ",~. ' :; , ";:if'yes~ hive date , .. , ' ; j ,' . ', ~" ': .~ , ;- !l ;', , :; ' ' , : , " : ,'~ ': ' : : " ' : '" ',i ' , ,'' i ':; ~', ,. , : ' ~' " · : : , ,; , : ' NO~-29-DI e8:21~ FROU-CT,~E ENVlR~ENTAL SRV 91~751H5301 T-54c- P.03/03 F-385 CT&E Environmental Services Inc. :'.l~Oj~'~l.':~. ~.~C~,~'; Drinking Water Analysis Repod for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLE i I:D BY,~/A'/~-~ SUPPLIER ] PUBLIC WATER SYSTEM I1~ ..PRJVATE WATER SYSTEM ' Warn' 8~m I~an'~..aa~ny ~ Cdy ~ , Slate 2Jp Code L3 s,nd ResultS [] Send Invoice ~g ~ress ~ ~m ~p c~ SAMPLE DATE: SAMPLE TYPE: i'l~OUtlne , · 1 Repeat Sample (refer to lab no, [] Treated Water [] Untreatod Water !~,~pecial Purpose Location Collected from: /~1£ p~' g '-F."'~ ' '-." 200 W. Potter Drive Anchorage, AK 99518-1 GO5 Tel: (gn?) 562-2343 Fax: (907) 561-6301 TO BE COMPLETED BY LABORATORY .~ia shows this Water 8AMPLE to be: timfactocy '[-I UnsaU-qfactory [] Sample char 30 houm old. Resu~ ma,/be unreliable. [] Sample too long In Iransi:. Sampla shOuld net be over 48 bra old for ana/ysia to indicate reliable re$,,IL~. Please send a ne~ sample via special clel~very mail. Date Received: Time Received; Analysis Began: Anelyllcal Method; '~ Meml3mne Fil~er MMO. IUUG Lab RG~ No. Result' . Analyst '" ' NumDeg ~ co4O~l~e,'J10Or!Il Sent to ADEC: ANC FBK JUN [] Fax Data: Tim,,' ~ Client netlflsd of unsatisfactory results: Time Collected Collected:. by (Initial): ~ BACTERIOLOGICAL WATER ANAYSlS RECORD MM0-MLIG Result: Total Coliform Membrane Filter: Direct Count VerlflcaUon: LTl] BGI~ Fac,-'l Coliform Confirmation: Final Membrane Filter R~ults: ~ Conv~ents: E. Coii COlonle~/10gml COLIFORM Time: [] TNTC; · Too #umer~ Io Ccx~ ~,!11,.,iii _~ MemOer ot the SaS Group (Soci6t~ G~nemle de Sun, alliance) li0V-29-11! 08:20AM FROII-CT&E EIWIR~NTAL SRV ,~tJ~., CT&E £mlmnmenl"l SerVices 'nc' ..... 90?5615301 T-549 P.02/03 F-385 CUent Name Project Name~, Client Sample ID Matrix Order~ By PWSID 1017998001' /!"' Tobhcn Spurldand P.E. Lot 2 Bk 2 Tah~ West Lot 2 Bk 2 Talus West Drinking War= Client PO# Pre-Paid Coils/N03 PUnted Date/Time 11/2812001 12:04 Collected Date/Time 1112012001 12:30 Received DateCrlme 11/20/2001 13:50 Technical Dire_clord, , Stephen C. Ede l~l~se~ ~ Wa=ara Department Nit~N ';, 'i'o. s0o .'. 0.500 mill EPA300.0 '[<10)., , -. .11/20/01 SCL col/100mL SMI8 9222B 11/20'01 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL. OF ON-SITE SEWER AND WATER FACILITY · , . 264-4720 Application Date I0 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name /tl~.~, I./~.l/.~.~t'~,~ Telephone: Home -~ ~/,_~-- ~7,~ ! Business Applicant Address ,I 19~'~ (~/;Io~-~_~- ~v'~¢ J i~nc~o~'c~ l~lc c/~/~'l ~ (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution kN/~e*-~l~' /'tc,~'fl'~/~'~'~' Telephone -~'~--~ Address ~O ~ ~o~ R ~n ~o ~ (e) Real Estate Company and Agent N,~. -- ~nc~ Address Telephone (f) Mail the HAA to the following address: TYPE'OF RESIDENCE Single-Family [] Mult~ Number of Bedrooms .~,~/ Other WATER SUPPLY Individual Well[] Community[] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. 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 {11/84) 5. 'ENGINEERING FIRM PROVIDI~G"'~INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION · As certified bY mY seal affixed herato and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply end/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 inspectionl the on-site water supply and/or Wastewater disposal system is in compriance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm F/~/~/~/~. '7~C/~ ~¢~/' ~'~ Telephone Address /~O ~c~O ~ ~ c~ ~ ~ ~ Date lO //~ Engineer's Seal Approved for ~.¢~,~_.~o.~ be Approved X Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Mur!icipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 , 72-025 (It/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ Well Classification ~r"tt/~n{"" If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) IN Date Completed J¢'71 Yield Total Depth ~' t~.~ Cased to ~' ~'~' Depth of Grouting ~0 ~* Static Water Level ~¢t$' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Pump Set At I ~ · ,2 e Sanitary Seal on Casing (Y/N) ~ Depression AroLnd Wellhead ~ .~ ¢, , . . '/6' ~ ¢,o. . ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 1~ ,¢~.m; On Adjoining Lots To Nearest Public Sewer Line iN,~. To Nearest Public Sewer Cleanout/Manhole .M~ A. To Nearest Sewer Service Line on Lot Water Sample Collected by t~'(~/-~/¢ /~c~,~¢~/ .~'e*'o"~¢.~ ; Date i0 ,/4 WaterSampleTestResults ~"c~-~x,~¢/-o,-,y--,OO ¢0{t.~"~'¢ or" B. SEPTIC/HOLDING TANK DATA Date Installed JO/f~/"// 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 '~"" ~ To Property Line TO Water Main/Service Line Course ;~, ~00 Size l ~O ~,¢1 No. of Compartments ir Air-tight Caps (Y/N) Y' Foundation Cleanout (Y/N) /~/ Date Last Pumped lO /l,~/l~" N,~- ; for /il, A, N./t'. Temporary Holding Tank Permit (Y/N) ~l.a~. To Building Foundation ! ~ * To Disposal Field ~0' To Stream, Pond, Lake, or Major Drainage Comments~ I,IJ¢l(- $~71'~¢ .~,,¢~.n~/'¢.~ ¢(u:/~a¢¢ uu, au I¢~¢~1 a~$ ¢n,,~e o~ Page 1 of 2 72 026(~ 11841 ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~&' ~'/B~ ~ ~97/ Type of System Design Datelnstalled 10/l~/71~'~j IO/l~/7{-~¢~LengthofField ~,~ Width of Field ~ ~ Depth of Field ~a~A ~ ~ Gravel Bed Thickness Square Feet of Absorption Area .~e~ ,~¢ Depression over Field (Y/N) Results of Last Adequacy Test .~'~'/~ --~/"~' ..-,-,-~ r Separation Distance from Absorption Field: To Water-Supply Well 108' =,.~r~ To Building Foundation ,~0 Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course Standpipes Present (Y/N) Date of Last Adequacy Test I0 / ! ?/~" To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) r,h/~. .~. lO0~ Comments D. LIFT STATION /~, A. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M CA and HAA guidelines in effect on the date of this inspection. Signed ¢"~"'~ ~" ~ Date Company /=[r~/'~,~, ~'-e~ ~e.t' MOA No. Receipt No. /~ ~ / 0 ~/ Date of Payment [ 0/~/~ Amount: $ ~ Page 2 of 2 12-026 (11/84) NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY pLAZA WEST, SUITE A FAIRBANKS, ALASKA 99709 907-479-3115 6957 OLD SEWARD HIGHWAY, SUITE 101 ANCHORAGE, ALASKA 99518 907-349-8623 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT [] PRIVATE WATER SYSTEM / ¥.¢3o ~c&, City State Zip Code SAMPLE DATE: lO I~ 80" Phone Mo, Day Year Purchase Order No. SAMPLE TYPE: ~ Routine [] Special Purpose [] Check Sample (for original contaminated sample with lab reference no, [] Treated Water [] Untreated Water Sample Time o. Location Collected 2 Colrected by 3 4 5 6 10 Signature of Representative .~-'~~ ~' ~ FOR LABORATORY USE ONLY TO BE COMPLE~D BY LABORATORY Received at: ~¥] Anch. [], Fbks. Date Received/I Time Received_ Next Sample Due COMMENTS: SATISFACTORY ~ UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Verification Final Count LSB BGB Result* Time DEPARTM~L~''G~A~'Y~'A~D~N~'I'~'~ ~ PROTECTION 825 L Street, Anchorage, Alas~ -99501 ~~ Da~e Received: A~ril 27, 1977 #1: Time 9:30 a.m. #2: Time #3: Time Date 4-28-77 Thurs. Date Date Insp Kennedy Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: o o Mailing Address: Property Owner: Mailing Address: Donald W. Albright Star Route A Box 1579V 99507 Phone: Phone: % Jean Smith, Realtor Legal Description: Lot 2 Block 2 Talus West Subdivision Single Family Residence: (x) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 3 Well System: Permit # Construction Individual Well (x) Conm]unity/PublJc System ( ) Depth of Well 112' Well Log on File Bacterial Analysis Sewage Permit # Septic Tank Size Absorption Area Disposal System: On-site System (x) Public Utility Installed 1971 Installer Manufacturer Soils Rate Material ( ) Distances: Well to Septic Tank to Sewer Line Nearest to Nearest Lot Line Lot line to Absorption Area Absorption Area Page Tw~ L.~/ ~ Department of Health and Environmental Protection Request for Appr,oval of Individual Sewer and Water Facilities Legal Description: Lot 2 Block 2 Talus West Subdivision Comments: Affadavit Attached.: ( ) Letter Attached: ( ) Disapproved: Date: Date: Department Worksheet: ~ ready to be picked GREATER ANCHORAGE AREA Department of Environmental Qualit~ "' 3330 "c st., Anchorage, Alaska 99503 - 27~-~6~ ,, 7 19/7 REQUEST FOR APPROVAL OF 1. Type of Inspection: CMRO VA FHA CONV 2. Property Owner: Donald W. Albright Mai-ling Address: SRA - Bo× 1~79V Day Phone 3. Name of Buyer: Richard H. Swenson Mailing Address: 2614 East 42nd 4. Name of Lending Institution: Not Mailing Address: ~hone 5. Name of Realtor or Agent: Jean Smith, Realtor Mailing Address: Phone Day Phone sure yet - probably alaska Mutual 6. Legal Description: Lot 2, Block 2, TALUS WEST SUBDIV. Location: Wilderness Street off Huffman (See reverse for map) 4 Type of Facility to be inspected: Residence No. Bdrms. 3 Water Supply Type of Supply: Public Utility Individual x If Individual, number of dwellings presently served 1 If Individual, depth of well 112' Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) Oct, 1971 X Eq-037 (~/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 251~East Tudor Road, Anchorage, Alaska 99504 276-2221 ~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES Type of Inspection: VA FHA CONV V/ 3. Name of Buyer: Mailing Address: Day Phone: 4. Name of Lending Institution: Mailing Address: Phone:. 5. Name of Realtor or Agent: Mailing Address: Phone: Legal Description: Location: 7. Type Of Facility to be Inspected: 8. Water Supply Type of Supply: ,~'I'Y~ f,,-L~- I~,R I'~iL ,.o No. Bdrms. Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal Svstem Type of System: If Individual, date of installation Public Utility Individual (on-site), 72 003(3/76) Page 2,of two pages - ~e~st Tor approval OT lnO1VlOUdl Legal Description Lot 2 Block 2 Talus West Subdivision Comments Disapproved Approval Valid for one year from date signed Greater Anchorage Ar6a 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) ~ ~ ~V// f~ ~/v - Department of Environmental Quality ~~ [,~30 "C" Street, Anchorage, Alaska 99503 274-4561 ~,~ . ~ Date Received September 20,1976 ~%~ ~ REQUEST FOR APPROVAL OF Buchho Conv. Donald & Suzanne Albright 1. Approval requested by: Mailing Address: Phone: 2. Property Owner: Phone: Mailing Address: Star Route A Box 1579-V 3. Legal Description: Lot 2 Block 2 Talus West Subdivision 4. Location: Wilderness Drive 344-1319 5. Type of facility to be inspected 6. Well Data: Individual A. Type C. Construction Sewage Disposal System: A. Installed 1972 C. Septic Tank: I. D. Seepage Pit: 1. E. Disposal Field: Distances: A. Well to: Single Family No. of bedrooms 3 B. Depth D. Bacterial Analysis On-site system B. Installer Size 2. Manufacturer Absorption Area 2. Material Total length of lines , Absorption area , Other contamination , Absorption area Septic tank Nearest lot line B. Foundation to septic tank , Sewer Lines C. Absorption area to nearest lot line __ EQ-O34 (1/74) ~ Page 1 of two pages GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "c" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested by: u~%/&. /~¢-~ /J&~ ~m/~-/*, Mailing Address: 2. Property Owner: -~/~ ~, Mailing Address: ~ ~o~ i.'~ 3. Legal Description: ~o'7~ ~- ~£.~ 4. Location: ~z]~/~e~ ~' 5. Type of facility to be inspected 6. Well Data: A. Type ~Li~) -~¢~ B. Depth Phone: Phone: No. of bedrooms 1/2 / C. Construction D. Bacterial Analysis Sewage Disposal A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal System: i~l~qJ~ B. Installer 1. Size I~ 2. Manufacturer 1. Absorption Area ~3G~q' 2. Material Field: Total length of lines Distances: A. Well to: Septic tank ~ ?~ , Absorption area ~/~0 Nearest lot line .~ , Other contamination ~-~ B. Foundation to septic tank ~ ~ , Absorption area C. Absorption area to nearest lot line ~0 , Sewer Lines /o ~, EQ-034 (1/74) Page 1 of two pages ~Page 2 of two pages - R ~est for Approval Legal Description ~ ~.~o~ of Individual wer & Water Facilities Comments Approved ~')e~,~.~,, ~L'g-~my~,~-[m.,..~~ Disapproved Approval Valid for one year from date signed Greater Anchorage Area Borough, Deoartment of Environmental DIAGRAM OF SYSTEM Date Quality certify that the information contained in this request for approval to be a true and ccurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) GREATER ANCHORAGE AREA BOROUGH. Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF VIDUAL SEWER & WATER FACILITIES Type of Inspection: CMRO VA FHA 2. Property Owner: Mai-ling Address:~c~z r~2~ ~§~ Day Phone Mailing Address': Day Phone CONV < 4. Name of Lending Institution: ~J~r .,~'~ ~ ~.~ ~',~ Mailing Address: Name of Realtor or Agent: Mailing Address: Phone Phone ~"7 6. Legal Description: Location: 7. Type of Facility to 8. Water Supply Type of Supply: If Individual, If Individual, 9. Sewage Disposal Type of System: If Individual, be inspected: Public Utility number of dwellings depth of well System Public Utility date of installation No. Bdrms. FY I n d i v i d u a 1 presently served Individual (on-site) Eq-037 ()/74} !~ /aartment of Environmental Qualit.~ ~Water and Sewer Questionnaire Date ~C~(9~ iD, , Time , Block ~ , Lot Owner's Name: .'~D gJ ~t 4 D ~. Mailing Address: Questions: ! 1. How many bedrooms are now in your house? 2. How many bedrooms were in the house at the time of purchase? 3. Were the basement bedroom walls "roughed in" at the time of purchase? o Was the basement bathroom plumbing "roughed in" at the time of purchase? ~ 5. Did the realtor or builder inform you that you would have to enlarge the existing sewer system if you finished the basement bedroom (s) ? 6. If on a public water supply, do you always have an adequate supply of water? 7. Is the pressure always adequate? 8. Who was the builder? ~"~ ~ ~)~) (~ ~ 9. Who was the home purchased from? OTHER COMMENTS: