HomeMy WebLinkAboutEAGLE ROCK LT 25CEngle Rock
Lot 25C
#075-092-70
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Water System Permit
Permit Number: OSP251307
Work Type: Well Upgrade
Tax Code Number: 07509270000
Site Legal Address: EAGLE ROCK LT 25C GA813
Site Mailing Address: 144 WADONIA WAY, Girdwood
Owner: SKORECKI RYAN
Design Engineer: LCG LANTECH INC
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
I)cpartill ell t
8/29/2025
8/29/2026
16640
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q 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
Special Provisions:
To close this permit please submit:
1. Well Log
2. Pump Install Log
3. Water sample results
4. Well Decommissioning Log
Received By: k' p C
Issued By:
Date. -
Date: V29
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 075-092-70-000
Property owner(s) Ryan Skorecki
Mailing address PO Box 1346, Girdwood, AK 99587
Site address 144 Wadonia Way, Girdwood, AK 99587
Legal description EAGLE ROCK, LT 25C
Number of Bedrooms 1
Engineering Firm Lantech
Building Permit Number
APPLICATION IS FOR:
(® all that apply)
Disposal Field
❑
Septic Tank
❑
Holding Tank
❑
Privy
❑
Well
[]
Water Storage
❑
Day phone 9073500016
Not Applicable 9
APPLICATION IS AN:
Initial
❑
Upgrade
El
Renewal
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
Permit/Rush Fees: g2_S
Waiver Fees:
Date of Payment: fs/25/ Date of Payment:
Permit No. 0992,91-7 Waiver No.
May 2025
Portion
Lot 26
Tract A
Portion
Lot 26
ry�Ar (147) iiouW (146' W
NV
n. (138')
.... "A
.4.4 h
H
AO
law
AMW
(145')
(146' Lot 25C
Portion
�, \ \\ Lot 26
4,
Iry
0
0501
1 44
'4'
Lot 2,5B
4
Lot 25D
'IN
Lot 23,F
Ij Lot 25A
449 t h-N L Star Lot
n 4�1 1-1
S1erv�yast� \ \ / �
0 20 40 "W
�M=�_ - I
US SURVEY LPq
NOTES FEEr 74),
-All dimensions shown -are grid bearings and ground distances, record boundaries are per Plat No. 2000-44.
-49th Star has conducted a physical survey of the property and all details shown on this Asbuilt Survey are correct. Under no
circumstances should any data hereon be used for the establishment of property lines.
-It is the owners responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed.
-All disturbed areas not covered with authorized installations are required to be revegetated.
-Bear resistant refuse containers to be stored inside until day of pick-up.
ASBUMT/PLOT PLAN SURVEY
LEGEND
49th Star Surveying
Lot 25C,
roj
Utility Pole
Drainage
PO Box 738
Girdwood, AK 99587-0738
Eagle Rock Subdivision,Direcdon
weu
(907)891-6111
Girdwood, AK
Tele.Com pedestal
(123') Spot
J6r"@49""I%fV#Wn9,COM
Electric meter
Elev.
W-0- 2435 FDATR 9/16/24
1
SCAIR V-40'
5A
144 Wadonia Well Map
L
2;B
1
\
f Lot 23F �.
I
�J
of 2{al.:• .
Q
�1
Lot 23G / \��
mrviry,„ g lcord.nrll will be si , dr Iled, an orhRleted/
o zo ao
n with ndards and
"m4_J in AM C .55 and 15.65��
us stlxvsY I;y
NOTES owner Ryan Skorecki
-All dimenxlons shown are grid hearings and ground distances. record boundaries are per Plat No. 2000.44.
-49th Star has conducted s physlcal eu wy of the property and all details shown on this Ashullt Survey are correct. Under no
circumstances should any data hereon be used for the establishmraI of property lines.
-It is the owners responsibliity to determine the 4rdslence of any emsemCnIs. covenants, or restrictions; no title research performed-
-AJi dLevarhed areas not covered with authorized installations are required to be revegetated.
-Hear resistant refuse containers to be stored inside until day of pick-up. 00
ASBUILT/PLOT PLAN SURVEYGWQ49th Star Surveying
ra� Utility Pale re GirdwoPO Box 738
od, AK 99587-0738
Lot 25C,e Rock Subdivision, tv Well Direction (9o7)s91Surve
EB.SI (123') � t leremy@49thStarSurveying.com
Girdwood, AK o Tele.Com Pedestal WA 2435 nATL 9/1e/24 •1
Electric Meter SCAM , •..{Il' .
t
_e' r
6
111
144 Wadonia Well Map
Lot 25C, Eagle Rock Subdivision
Girdwood, AK
Well will be sited, drilled, and completed
in accordanceFters
.dards and provisions
in A ha5.55 and 15.65
owner Ryan Skorecki
Tract A P
L�
' )
((146'
L(0)it 2.5,1B�
l
(148') IP) (0)1C
%%h, IL(o)
r� Ve
ISC
.t
l
� v
•00
M�
c _C�
ALYY) M.UCalinl Vft ,
o?
C4
Oct -20-06 01:37pm From -
T -334 P.001/001 F-106
Waiter Wel('Drilling (ttd Airily, Ser%*a
Well Log
An {70Yntid, 'RIASI t �nOJ) 7)S'JS:�:
11 /�r� r� rip
llrillinu Starlc0: 10;082008(',,117pie,vd: 10,,09 2008
C'i,yr l3urou h: 5rybtlivision: BLOCK LOT
Pro(mrty O,vncr Nume& Addmss: Kristian Sieling
P•,O. Box 92 Site:Wadonia Way
Glydwood, AK 99587
Girdwood Eagle Rock 25c
.Meridian i owwhip Ran c Section I/4 of _ 4 of _ _ YJ of
BOREHOLE DATAffrom top of easingpepth
Drilling method: (X) Air roctry. t ) Cable tou), Orher __ _ .....
Material: Type, Calor &wvuless Fran, To
Well use: ( ) Public supply. t X) DomLslic, Other _.. —
stickup
0
2
Depth 01'1101C. 104 li, casing stickup; .— --f,
Casing rypc:Steel _ Thickness: _.250inches
Overburden
2
4
easing diamerer: ,.._ 6.--. inches c' mmil (omni: _ 104 ft
Liner type: �__ Diameter: _, inches Depth: li
gravel w/ clay
4
12
Stade walcr(from top ofmiog):.84__•. ti on 10'09, 2008
Pualping Ivvel S Vivid: ficel atter lours al gpm
_ — ..
Recovery rate: 155 gpm, Method al'tes(ing: airlift
Development method: airlift Duration: 1 hour _
silt &gravel
12
38
wet silt & gravel
38
43
Wolf intake opining Type: (X ) Open end. ( ) Open hole, Other.
4crcenl.d; Start: - 11, Stopped.
silt & gravel
43
94
Screenty�(tc - Slotimesh.ize:
Performed: Scut:,,_,_ - Il, Stopped: _... -_---_- .- ....... ll
wet silt & gravel
94
100
Start: --__. — n, stopped: ._.__._-_.__ li
Note: ...................................................
gravel w/ H2O
100
104
Grout type: _ _,tntonite volume
neplh: from ground surface , to 2.0 ._ t
Pump inmkc depth: ........... li
Pump size: - hp. Brand name:
Was well dis(nfemed upon completion? ( X) Yes, ( 1 No
Mctlod of duinfcctioa:OialGil, M.H =hlorite.(.Chlorine)...
Driller commems." disclaimers.............................................................
.... ........I _ ........... -................................................................
....................................................................................................
1-'eltdrillernanw;. Seth
Company name: .... defty Drillingt Inc. ........................
Maihngaddre��:...3540.Akula Dr ..............................................
city: Anchorage State: AK zip 99516
Phone uutnbor: (,_._907 ) 345 _ 0593 Nx:345-4700
DrilluN, signature.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Section
4700 South Brapw St.
P -O- Box 196650 Anchorage, AK 99519-6650
www.m un i.ott;/onsite
(907)343-7904
Attention: Properly owner shall provide a well
DSD within 60 days of well completion.
Permit Number: SWO70297
Dare of Issue. Oct/ 30 /20)07
Parcel Idcntificntion:Number: Q75 — 092-70
N well located at approved permit luwtian' (X) Ybs or ( )
log to the
No
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: Oct 30, 2007
Expiration Date: Oct 29, 2008
Permit Number: SW070297 Parcel ID: 075-092-70
Legal Description: EAGLE ROCK LOT 25C
Design Engineer:
0000 ZZ - NONE NEEDED
Site Address:
NHN WADONIA WAY
Owner Name:
KRISTIAN & FRED DIELING
Lot Size:
16640 SQ. FT.
Owner Address:
PO BOX 92
Total Bedrooms:
3 Permit Bedrooms: 3
GIRDWOOD , AK 99587 -
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 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.
iCIV1,4W ' we I I r e 10 co,4d ?-W t4tkV stt6km-; ht, Ile
1
Received By:
Issued By:
Date: 14 14 m'
Date: 89ZLO A
Municipality of Anchorage
:-,Development Services•Depadment
if Building Safety Division
-j On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
ON-SITE SEPTICIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015- O l Z 7-70
Property owner(s) VR - r7A<y) 51 1-irJLI Day phone ZZ-, - IZ 2 7 -
Mailing
Mailing address F6 folic 97 61cowcoD M4 Zip Code 1426
Site address \rJAp04IA WA`t Zip Code C1g5$7
Legal description (Sub'd, Block & Lot) f^ RC, L E ROCK L -r '25 C -
Legal description (Township, Section & Range)
Lot Size (_G 0 Sq. Ft.
THIS APPLICATION IS FOR (®all that apply):
Absorption Field
❑
Septic Tank
❑
Holding Tank
❑
Privy
❑
Private Well
A
Water Storage
❑
Number of Bedrooms
THIS APPLICATION IS AN:
Initial
Upgrade
❑
Renewal
❑
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 of author'izAl agent)
PermiVRush Fees: %-73 Waiver Fees: _
Date of Payment: lO j�_q Date of Payment:
Receipt Number. Receipt Number:
(Rev. 17105)
iolmlos
Alyeska Hwy
SITE PLAN for EAGLE ROCK SUBDIVISION LOT 25C
j; Kristian Sieling - Owner 10/8/2008 Scale 1"=50'
4
HLB L d
li I
-} t
well
I
I manhole
I
'�- u iise a
p . c
t pnv to ew
O S
E
t '
rad
t
rad I
I
t well
5' rad I
I
I
t
a
y
0 1 rad I
Private . I
rl Access I
I Easements
I utility
easement
I - o
t
t -
WADONIA
t
I WAY
A
s utility
easements
t
I I
Alyeska Hwy
SITE PLAN for EAGLE ROCK SUBDIVISION LOT 25C
j; Kristian Sieling - Owner 10/8/2008 Scale 1"=50'
4
MUNICIPALITY OF ANCHORAGE
�r15Pcz__rC Ij0 3 - ansa
gWc.q--7g3_aEyS
WATER & WASTEWATER UTILITY
3000 ARCTIC BLVD.
PHONE: (907)564.2762
WASTEWATER
CONNECT PERMIT 07-5552
DATE OF APPLICATION 07/17/2007
SCHEDULED COMPLETION DATE 12/31/2007
BLOCK/LOT/TRACT LT 25C
C SINGLE FAMILY
SUBDIVISION EAGLE ROCK
❑ MULTI -DWELLING No. APTS_
n COMMERCIAL
TAX CODE 7509270 GRID
SE4813 AS -BUILT
STREET ADDRESS NHN WADONIA
OWNER
A PHONE
MAIL ADDRESS PO BOX W GIRDWOOD. AK 995870288
CONTRACTOR 'UNKNOWN
ASSESSMENTS
Repair Existing Service
QX Main Line Extension
�X On Property Only
n CltyTap
Have Been Levied
Hydrant Only
50' or Longer
To Be Levied
Main Tap -To Property Line Only
Comments:
❑ Main Tap & On Property Connect
Row No.
Disconnect
R & R -Main Tap Only
CONNECT SIZE 4
ISSUED w. cm
INSPECTION FEE $ 54.00
PAID L] CASH
PERMIT FEE $ 48.00
C H E C K # /eDlo�
$ 0.00
{tj OTHER
DEPOSIT $ 0.00
INSPECTED BY
REIMBURSABLE
02.00
TOTAL $�1
NUMBER
DATE / /
REMARKS
PERMITTEE (Please Print)
MAIL ADDRESS (�c
SIGNATURE (�
PHONE 2Z7-17Z2-
POST
ZT-12Z2
2
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
CUSTOMER COPY Original
01/01/2006 00:12 19077830288 COLLINS FLOORING `
dump. Installation Log, UXAYM w�a
wtu
ABOVE aao.Ko
CASW. — --
PAGE 01/01
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OPp 110tE_'„_C.�' To
well was disinfected upon completion.
i method: calcium hypochlorite.
DnCRne, Zn
n
Water Weff and Pump Service
gLncharave, 9traska
�907) 34S-0593
j
'rt Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 075-092-70
1. GENERAL INFORMATION:
Expiration Date: 1 0 — q " Z- (
Complete legal description EAGLE ROCK; LOT 25C
Location (site address) 144 Wadonia Way *Girdwood 99587
Current Property owner(s) Jessica Seiling Day phone
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
1
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
❑
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
WaiverNariance request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 2- 8 C7 I Waiver Fee $ _
Date of Payment -7 1 1 10,091 Date of Payment
Receipt Number Q 9 18, 6 Receipt Number
COSA # 0S C2/ /3 79 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 EastTudorRoad, Suite 101 -Anchorage, Alaska 99507
Engineer' . s Printed Name: Jeffrey A. Garness Date: (2,f
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for
Disapproved
Conditional approval for
0
bedrooms
bedrooms, with the fol
. . .. .. . .. . ... . . . ... .. .
ev A. Gcrbess.-'
1.41 C
e s
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N U T Y
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D s t i p
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9) 'S"
Original Certificate Date: -7-c(,Z
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
0.210
Y;-X/
..........
. . .. .. . .. . ... . . . ... .. .
ev A. Gcrbess.-'
1.41 C
e s
#AECC884
N U T Y
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D s t i p
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9 1 ts. NN , ,
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Original Certificate Date: -7-c(,Z
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
0.210
OSA Checklist
Legal Description: EAGLE ROCK; LOT 25C
Parcel ID: 075-092-70
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
VVell log is filed with Onsite (or attached)
Date drilled 10/9/08
Total depth 104 ft
Cased to 104 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 6/13/21
Static water level at beginning of test 82.1 ft.
Comments
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION! FIELD DATA
Which system tested (date installed)
❑ ALL standpipes present per record drawing
Total measured depth from grade ft (max
Measured depth to pipe invert from grade ft
❑ N/A - pressurized field
❑ ivionitor tubes go to bottom o!'effective. If not, st
depth into effective
Code -required soil c er over field
❑ System preso d
(Required if v- nt for greater than 30 days prior t
date of to
qXns introduced gallons
ments/Deficiencies:
COSA Checklist yellow sheet
Well production at time of test 4.9+ gpm
Water storage tank volume NSA gallons
WII disinfected for coliform test? F-1Yes [0-1No
Coliform bacteria is Ne ative
Nitrate mg/LN'trate less than MRL (ND)
Arsenic ug/L Vsenic less than URL (ND)
Collected by GEG, LTD.
Date of Sample 6/13/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:'
Zequacy test date
Results ❑]Pass For bedrooms
Fluid depth prior to test in
(min) Water added gal
New depth in
ate Elapsed time min
Final fluid depth in
Absorption rate gpd
o Any rejuvenation treatment (past 12 months)
If yes, enter date
AWWUSEWER
ata
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
NSA
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No ft
❑✓ Yes
if No_
Neighboring Tank? 100' ❑� Yes
if No ft
Private Sewer/Septic Line > 25' ED Yes
if No
Absorption Field on Lot > 100' ❑ Yes
if No NSA ft
Holding Tank > 100' ❑✓ Yes
if No _
Neighboring Absorption Fields > 100'
Water Service Line > 10'
Animal Containment > 50' ❑✓ Yes
if No _
❑✓ Yes
if No ft
11,�`
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑✓ Yes
if No ft
❑✓ Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required
Building Foundations > '10'
❑ Yes
if No
ft Surface Water > 100' ❑ Yes if No •
Property Line > 5'
❑ Yes
if No
ft Wells on Adjacent Lots: / J
Absorption Field > 5'
❑ Yes
if No
ft Private Wells > 100' Yes if No.
o-
Water
Water Main > •10'
❑ Yes
if No
ft Community We Is -.-,'200' E]Yes if No
Water Service Line > 10'
❑ Yes
if No
ft q aseptic -t nk is under driveway comment below
11,�`
ft
ft
ft
ft
ft
ft
ft
From Absorption Field on Lot to: (Please enter distances-ifl"ess than required)
Building Foundation > 10' ❑ Yes if N ft If absorption field is under driveway comment below
Property Line > 10' P— s if No ft Wells on Adjacent Lots:
Water Main > 10' ElYes if No ft Private Wells > 100' F1Yes if No ft
Water Sere ine > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft
StVacee-W"ater> 100' ❑ Yes if No ft
F. ENGINEER'S COMMENTS
*NO MANHOLES LOCATED - SEE AWWU CONNECT CARD
G. ENGINEER'S CERTIFICATION
1 certifythat 1 have determined through field inspections and review Vl
of Municipal records that the above systems are in conformance with G' C �� �?T�,• ' j� ��
MOA COSA guidelines in effect on this date. ,� u ; , i,`: j ( ..........
COSA Checklist yellow sheet
1 ey A. Gbrness•-
Profess+00o a
MECC884
nAl
PRG>CSE'D P3iMIED FUCA I
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UNDER NO CIRCUMSTANCES SHOULD AN AS-BU!LT BE USED PCR CONSTRUCTION OR F'OR cSTASLIISH;SG BOUNDARY OR rukCF LINES.
THE SURVEYOR "TAKES RESPONSIBIUTY FOR THE ENM'AL nA IS;C70,N ONLY AND ASSUMES FiNA.NCIAL LIABILITY 04NLY FGR THE COST OF THE SURVEY
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=LOT PLANS & LOT SURVEYS ; ;COTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS .AND TO DE TI=RM!NF
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTPONS
RICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
SURVEY CERTIFICATION
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ONLY THOSE MI..PROVE RENTS ABOVE. GROUND AND VISIBLE WLL BE
SHOVYN. FENCES. WELLS, S= ?TIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
ETC., ARE SHOI&W its, THEIR APPROX;IJA E: LOCATION. ONLY. SNOW
MAY PREVENT SOME IPAPROVEMENTS FROM BEING SEEN AND LOCATED.
ALL DISTANCES ARE RECORD UNLESS OTHERVASE NOTED.
Prepared by
Robert- F. Jo ins, Jr. & Assoc;.
Professional Land Surveyors
1700 Brink Drive.
ANCHORAGE, ALASKA 99504
Scolc: V1 _ ^00' 'Rec
0''Rec- !Root S.F. IRec. Plat Fila Na.
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EAGLE ROCK
LOT ?5C:
MUNICIPALITY OF ANCHORAGE
WATER & WASTEWATER UTILITY
3000 ARCTIC BLVD.
PHONE:(907)564-2762
BLOCK/LOT/TRACT: LT 25C /
SUBDIVISION: EAGLE ROCK
TAX CODE: 07509270000 GRID: SE4813
STREET ADDRESS: 144 WADONIA WAY Girdwood, AK 99587
OWNER: SIELING KRISTIAN W 50% & SIELING FRED H 50%
NIAIL ADDRESS: PO BOX 92 GIRDWOOD, AK 995870092
WASTEWATER
CONNECT PERMIT 21
DATE OF APPLICATION: 06/0312009
SCHEDULED COMPLETION DATE: 12/31/2009
RX SINGLE FAMILY
❑ MULTI -DWELLING No. APTS 1
❑ COMMERCIAL
PHONE:
CONTRACTOR
ASSESSMENTS
Repair Existing Service
❑ Main Line Extension
On Property Only
❑ City Tap
X❑ Have Been Levied
❑ Hydrant Only
❑ To Be Levied
❑ Main Tap - To Property Line Only
Comments:
XJ Main Tap & On Property Connect
Row No.
❑ Disconnect
> ❑ R & R - Main Tap Only
caner I Staff r / '
CONNECT SIZE 4 in
ISSUED WWMSR
INSPECTION FEE $ 98.00
R PAID ❑ CASH
PERMIT FEE $ 3.00
❑ CHECK #
$ 0.00
Q OTHER
DEPOSIT S 0.00
REIMBURSABLE
INSPECTED BY f—'r..,?
NUMBER
TOTAL $ 161.00
DATE If t-( O cj
REMARKS
P—IMITEE (Please Print) SIELING KRISTIAN W 50% & SIELING FRED H 500/cPHONE
Mi,iL ADDRESS PO BOX 92 GIRDWOOD, AK 995870092
SIGNATURE
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
INSPECTOR COPY
DATE SCHEDULED '12/3'1/2009 TIME 12:00 am INSPECTOR f�_rej ��o
SUBDIVISION EAGLE ROCK BLOCK/LOT/TRACT LT 25C /
INDICATE NORTH
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SIZE MAIN: 1.
TYPE MAIN:
DEPTH AT MAIN:)
TPROP. LINE:
CONNECT LOCATION:
COMMENTS:
INSEPECTED BY:
DATE
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