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- i 7�ormerly US Survey 3043
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STATE OF ALASKA
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24505 Teal Loop Chugiak, Ak. 99567
Girdwood I US Survey 3043 19B
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µell drille, sunk' nlohnny, Kay....._ ...............................................
company 1tame:...i.e.fy.pfltlim..tn4.s. ..........................................
Mailingtlrl.lrtss:.3540.Akula Df ....................................... _.........
cur: Anchorage _ _slate: A.K iill99516
Phone num:x:r ; ( 907 ) 345 0593
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Alu'hmaee, AK'Mpll-M-44 J-iw Yes or No
I'llow p1t700 ;6)4 and roe 190712-r.v\447 Is well kx:mcd m upproocd permit h>Lat,on'! l X) l 1
MAY -23-2013 07:53F FROM:
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Office 907-345-0593
Curt! e07-240-8911
Johnny 907-830-9985
cmaik hettydrilling@aol.com
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 995196650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Permit Number: SWO50158
Legal Description: US SURVEY 3043 SUBDIVISION LOT 19B
Design Engineer: 0000 None Required
Owner Name: RACHEL SAXBY & DAVID OSBORN
Owner Address: 24505 TEAL LOOP
CHUGIAK . AK 99567 -
Date Issued: Jun 02, 2005
Expiration Date: Jun 02, 2006
Parcel ID: 075-092-09
Site Address: 24505 TEAL LOOP
Lot Size: 29500 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked 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.
5. The following special provisions.
-THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55.
PLEASE SEE THE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IT IS
THE BURDEN OF THE PROPERTY OWNER TO DETERMINE THIS WELL INSTALLTION WILL NOT AFFECT
THE FUTURE DEVELOPMENT OF THE SURROUNDING OR EXISTING LOTS. WHEN THE WELL HAS BEEN
COMPLETED AND SATISFACTORY WATER PRODUCTION HAS BEEN DETERMINED, THE WELL DRILLER
SHALL PLACE AN APPROVED SANITARY SEAL ON THE WELL HEAD AND NO PITLESS ADAPTER OR PUMP
SHALL BE INSTALLED UNTIL AN APPROVED WASTEWATER DISPOSAL SYSTEM HAS BEEN CONSTRUCTED.
IF THERE ARE ANY QUESTIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER
PROGRAM AT 907-343-7904.
Received By.
Issued By:
Date: '71/ / 47 5
Date: &A -.k
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/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 07 5 - Oq2 -oq -Ooo -o& Permit Number SW
Property owner(sRAAPJ ,Sa�464 1 Da✓,r% O'Sb0(' . Day phone ;�1/11-00914
Mailing address ay$a S _re ► Zip Code qqs& 7
Site address Loa 1q R Al, C44. IA;u r�rclwaaci Zip Code 99587
Legal description (Lot, Block & Sub'd.) IT t 9 O, R T100 'R. -JF Sec 1$
Legal description (Section, Township & Range) SP -c, 19 T ION 'RAE
Lot Size .2q SOO Acres/Sq.Ft. Number of Bedrooms Ll
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only 19
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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)
Permit/Rush Fees:
� • eD Waiver Fees:
Date of Payment: /3r�� Date of Payment
Receipt Number: ceipt Number.
(Rev. 09/04)
111=30'
PLOT PLAN
GASTALDI LAND
SURVEYING, LLC
JEFF A. GASTALDI, R.L.S.
4726 WEST 88TH AVENUE
ANCHORAGE, ALASKA 99502
PHONE 248-5454
GRID I DATE
4913 5/6/2005
F. B. JOB NO.
USS3043
67-79
U.S. SURVEY NO. 3043
LOT 19B
29,514 S.F.
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it
RELATIVE ELEVATION FROM ASSUMED DATUM
I HEREBY CERTIFY THAT I HAVE SURVEYED
THE PROPERTY DEPICTED ABOVE AND THAT
THE PROPOSED IMPROVEMENTS AND DRAINAGE
PATTERNS ARE AS SHOWN HEREON. IT IS THE
RESPONSIBILITY OF THE OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY THE PROPOSED
BUILDING LOCATION ON LOT, BUILDING
DIMENSIONS GRADE AND UTILITY CONNECTIONS
AND TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED
SUBDMSION PLAT.
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