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HomeMy WebLinkAboutKASILOF HILLS BLK 7 LT 3KasI*Iof Hills
Block
Lot 3
7
#015-161-1-2
�( r
Municipality of Anchorage :f
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program. 4700 S. Bragaw SL
P.O. Box 196650 Anchorage. AK 99519.6650 Page of
www.ci.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: G\V0q09060
PID Number. O 16— 16 1—,_12-
N, L C !i a atm tµ
Wastewater System: El(H New upgrade
"*as$ABSORPTION
106`41 o
bE v VJ_'
FIELD
Prone
NwM.r of 9.emma'
❑ ONM
Daae Trendl O SMAOw Trench O Bad O Mawlcl94
LEGAL DESCRIPTION
SW Raft
/. 2 P Fa
Tar D.pel Dan a gW Or.cla: i
I F• '
a WG.arom
—
Daph m PM Donau hom orlgelal www:
Gray own wroath P a:
7 3
14 / s
FI.
T~,Wp RMae
Srlwn
Fa sOW stmO"NO Oracle
Grrvr Lonprh
�0
FI.
Fr.
❑ New
❑ Upgrade
Grayr WW11\
2
NN•iwf of total
D•alarlCl wrMM4Ma
FI.
Well:
FI.
c: lvfca on (PmN•. A e. Gk
TOW D.Pe"
cases m:
Tar aDaaPoen Yat
Fla
P"e"ars"".
10 C 3G3
Fl.
Ft
,
D•w.n ��
Dab D~
SMIKwrOL"at
NFWIM
Dale aulaw
5
FL
Tleln Y Pu" Sad aLGaa.•iHBVNr'm•+cra.,a
TANK
GPM
Fl. R
SEPARATION DISTANCES
dseptic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
PubIIUPMat
Sewertlne
MaMW.W..
AtjC14.•'
Ca>acly
wan
115
Ito
—
—
4S
Ma1MY.
STEt^L 1061
Nu• ca,a Co w."Ns
2'
Sunacawaw
q1"
nt�o
t--
LIFT STA 71ON
SKI.
M.r1Y1KIwN
La Line
'Pwr• an' Nvr aL
'Pwnp elf Mva L
Hly+w.:r r.rm n
/
Pump Matra a MOOr
EbanFal sp.cba4 grlanseO Dy
cw swl D,*A
N f v
N10
I
I
Remi"'BENCH
/
MARK
O «n .r
tt
w ,
Laawn and DaunWan .�/
Y leek W' Co rsi e i euTI
.,
r /
/l4�
A iii E�a:xn.
Ido FI.
I
ErggeS'j-4St��
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/
'
Inspections performed by:
�. Saurl;,fnaa Dates: 1" o / oy
;•
7 0�
Developm
rat Services Department Approv I
I.,I I
air
Re vii wl ed and approved by:
Date:
q
I I I -
I 1 �•= I I
I
I I I I
WSTAL EV TB£Na1
40 Tr LONG
15 Tr
7.5 Nn7rcm Rock
I
TANK � hell
A I 1
SKW
AC 510 rT 23.0
' £•� ~ • • • • AD 673 fT BD 5 I
•.• A£ 45.0 FT B£ b. I
C Ai 67J TT Bi 51.0
' � I
D BENCH
i
B W DECK
I
I AMDOWD
COUAPSAW LOG CA18
bell I�j Yell
OF Nit I
:• 49th *�
1 •...» .. ............ ;
LOT 2 4� BE sPurna
1 1 ��l No. 25
\ � I
R5 o zs so 75 Tzs Tso
SCALD 1' = 50
WHOM SNUNKLANU P.L. LOT 3 BLK 7 KASILOF HILLS SEPTIC SYSTEM AS BUILT
203 W 15TH. AVENUE LESLIE BACN/ DATE. JULY 11, 2004
ANCH. AK. 99501 907 279-3916 11 10841 STROGANOF DRIVE SHEET. 2/J GRID: 2641
PERMIT #SV040230 PID # 015-161-12 KAH07032DVG
Standard Trench,
2' Vide
40' Long
16.5' Deep
7.5' Sewer
9' Cover
S!( t
0
Monitor
rio„n.,,,+C
1250 got Sept/c tank
KAVY Durr
V
G
0
a
3
i°
W.8 eaa
7.5 ft of Septic Rock
Effective 1250 gal. septic tank
WAVY Durr
Nil SCALE �3 t
WKH wax.•
AS BUILTTOP c 1 Fr rCX SW CORN& Or"�'
203TOBW1 th Ave AND P.E. LOT 3 BLOCK 7 WILOF HILLS SEPTIC SYSTEM SCHEMATIC
An orage Ave LESLIE BAGNi DATE JULY 12, 2004
Anchorage ge Ak 99501 10841 SWUMOr DRAT SHEET
11 3/3 GRIDS 2641
PERMIT SW040230 PARCEL ID # 015-161-11 CTA02093.DWG
s
MUNICIPALITY OF ANCHORAGE
Development Services Department
I 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
Initial
Permit Number: SWO40230
Legal Description:LKASILOF HILLS BLK ,.7 LT_ -,.3 ?
11�/ter /a
Date Issued: Jun 29, 2004
Expiration Date: Jun 29, 2005
Parcel ID: 015-161-12
Design Engineer: 0007 Tobben Spurkland, PE Site Address: 010841 STROGANOF DR
Owner Name: Leslie Bagni Lot Size: 31153 SO. FT.
Owner Address: 10841 STROGANOF RD Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99516-1253
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.
Received By.
Issued By
Date:
Date: G -e2 9 — O it
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.ek.us
(907) 343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0/5 - 110 1- 12 Permit Number SW d LI -0 30
Property ownersDay phone 3N6 - 02/01
Mailing address (1) 10841 sT2o&ANOF D(a.
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) LOT :� BK 7 ILASI L.o t` N 1 LLS
Legal description (Section, Township & Range)
Lot Size 3 (. I S3 Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms V
Sewer Only i�*_ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade R
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 Fees: yGa Waiver Fees:
Date of Payment: 1410q Date of Payment:
Receipt Number: $ 3 Ip a to '� Receipt Number:
(Rev. 12100)
Ti'.STUPELAMD P.E.
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907)279-3916
Fax (907)-276.6013
SEPTIC SYSTEM DESIGN
LOT 3 BLOCK 7 KASILOF HILLS SID
LESLIE BAGNI
Municipality of Anchorage June 10, 2004
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
Anchorage, Alaska 99519-6650
We are submitting an application for the upgrade of the septic system for this lot. The submittal
consists of three (3) drawings showing the present improvements on the lot and the adjoining
properties, (sheet 1/3), the proposed improvements of the lot, of 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 of applicable testholes are also enclosed. The septic system design is
based on the following:
Outlet of existing tank 8 feet below ground surface.
No Ground Water or Impervious Layer to 24 ft.
Use Standard Trench
Soil Rating. From Test Ilole 05-27-04
3.6 min/in - 1.2 gal per sq.ft/day
No. of Bedrooms 4
Required Area per Bedroom: 150/ 12 - 125 sq.ft.
Total area required: 125 x 4 - 500 sgft
Bottom Rock At 15 feet
Top Rock At 9 feet
Rock Depth 6 feet
Minimum Trench Length 500/ 12 -42 ft.
Use 50 ft
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH
50 FT
TOTAL WIDTII
2 FT
TOTAL DEPTH
15 FT
ROCK DEPTH
6 FT
COVER
9 FT
SEPTIC TANK
1250 GAL
The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent
lots. With 9 feet of cover the top of the drain field will be more than 35 feet distant from a slope steeper than 25 %
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.
LOTS � I
I I
I ,
I A
L 4
_Nlle j
� YAGNI I
LOT LOT
S �
P
:• 49th
4,
— OC CRIB„
3EFN SPURKLAND
No. CE -2223
50 0 50 ittl 150 m 250 300
SCALE, I' = 100 FT
B
�I
I
II
II
II
I
I
II
II
I
I
\ I
II
� II
\\ I
I
II
V
V
TOBSEN 5PURKUND P.E. I ( 10841 STROGANOF DRIVE SHEET.•�
LOT 3 BLK 7 KASILOF HILLS I I SEPTIC SYSTEM DESIGN I
203 W 15TH. AVENUEANCH. LESLIE BACN/ DATE. JUNE 9, 1001
lon7)970-'401,;AK. 99501 1 3 GRID: 1641
om) .
I PERMIT l/SW040XXX PID 4 015-161-12 KAH07031.DWG
-- - - - - -- - ---------
'..- `L
I I �•• I I
I I I
W Lr. TAMCH
50 IT LONG
15 m ocEr I
611 nnCMr ROCK
BICXii=put
1AW Y Bell
5 I
•' I 1
I I
P-
� O I
I
I AAMDON I
C&1 psw LOG am
ell I �j fiell
I Q lY I I
I ���aaaaa�
I1 •''•P�� ,••♦
1 49th `#♦♦
1 �......./..TOE •
LOT 2 ��'� TOB N SPURKL i
1 ♦. •lam:
a�aaaaaa��
\ � I
n o zs so 75 I25 Iso
SCALEr I' = 50
10118LN 5PURKLAND Il.I I LOT 3 BLK 7 KASILOF HILLS I I SEPTIC SYSTEM DESIGN
103 W 157H. AVENUE LESLIE AAGN! DATE. JUNE 9, 2001
(907) 279-3916
(NCH. AK. 99501 10841 STROGANOf DRIVE SHEET.• 2/3 GRID. 2641
PERMIT IISV040XXX PID ♦ 015-161-12 KAH07032.DVG
0
.�. 0
3 1250 gal Septic tank
Standard Trencht o W-Avv am c
6
2' wide %J50' Long m o
15' Beep •0 0
6.0' Sewer rock o c
9' Cover a .�.��� QF �w��,•♦♦
.,`P .............. �
;•'♦i
49th '•�
�
.......
%................................
�•
Tog N SPURKLAMD
♦� No. ce-2225
••
NO SCALE .........♦♦
Mon/tor
Cleanouts
9' Cover
Silt Barrier
6.0 ft of Septic Rock
flleclive 1250 gal. septic tank
WAVY air
NO SCALE
TOBBEN SPURKLAND P.E. LOT 3 BLOCK % KASILOF HILLS SEPTIC SYSTEM SCHEMATIC
203 W15th Ave LESLIE BAGNI DATE JUNE 10, 1004
Anchorage Ak 99501 fW41 Sn?OGdNOF aw1YC SHEET. 3/3 GRID, 2641
PERMIT SWO40OXX PARCEL ID j 015-161-11 CTA01093.DWG
Municipality of Anchorage
Development Services Department
Building Sa!ey Division
Onsite Water and Wastewater Program
4700 South Bragaw SL
I� P.O. Bos c Anchorage. AK 99519•6650
wmvr
vnwanchoraae.at.us
(907) 343-7964
Soils Log - Percolation Test
ver'c�ed For: L —5 /i C- Dale Performed: g" ;27.0y
LS -21 DescnObeni gK'7 llhS14OF Township, Range, Section:
Cl.. Siln Plan
De; ,.h
SaMt/
2-
5-
7.
•5-7• 5i//l><y SnucQ
rut►» t•o y n
- ! t
Fq .7
e
v
" r
R �
P-tA:..Er;Ts isl
WAS CROWD WATER
Gross Time I
E.`:CCU::TE=EDT
SID
Pie!D•:^.
s
IFY"e S. AT WHAT DEPTH?
E
0
Depth to Wale, After
Elonitodng?
P
E
I►a/y I
/
4 7( // D y
Dote:
ReadingDate
Gross Time I
Net Time
Depth 10 Water
Pie!D•:^.
17ti
-7—
I►a/y I
it
/OWN"
I I'�z I
I I/ : la I
t o
I 4�
I ,2 j�•1
11 3�y I
I 11 : LB I
10
I 83/y
3/1
113%
1: 36 ,I
10
I 70
23/+
11 3%y
wo,
10
q0
23�
.
►! :�ti
ID
1
I � 3�
FE4_CIaTICH PATE F?RCF:C:EDI:'.1_TER
TEEi RU`f9ET`NEEII ��FT MO rt
I n _I _ of J _ •t .. 1_
nut
=E=FCR`.I°D BY. et /.5 CERTIFY T- AT TRIS --S ";,-SPER=ORMEO IN ACCORDANCE WITH ALL STATE AND MUMCIPAL GUIDELINES IN EFFECT ON T'r.IS DATE. DATE: b 9 0
I
b %=1 9?
a'/L
TRENCH
GRF ER ANCHORAGE AREA BC UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME -�' JJ /In 5C" MAILING ADDRESS'`% >`✓I l tf f 6i /y' PHONE
LOCATION/ £p
LEGAL DESCRIPTION �J/
SEPTIC TANK:
DISTANCE //. NUMBER OF
17ROM WELL '4 MANUFACTURER e/" %lF`� r. _ MATERIAL
COMPARTMENTS
INSIDE LENGTH J —INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY �i:'•'�' GA
SEEPAGE PIT: X10
NUMBER OF PITS i DIAMETER OR WIDTH, LENGTH /_'-/, DEPTH
LINING MATERIALX�Mell , CR, CRIB SIZE: DIAMETER_DEPTH_6 f DISTANCE FROM: WELL L>zii'
a'. �r , TOTAL EFFECTIVE
BUILDING FOUNDATION? NEAREST LOT LINES . ABSORPTION AREA (WALL AREA) SQ. FT
ADDITIONAL ABSORPTION
WELL: ✓✓��
TYPE 1 �t���� --'-' _CONSTRUCTION / o� 12- 1" 'Gfi%) DEPTH
BUILDING NEAREST NEAREST SEPTIC
FOUNDATION LOT LINE SEWER LINE TANK _
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
DISTANCE FROM:
SEEPAGE
-- , SYSTEM
DIAGRAM OF SYSTEM
INSTALLED BY: �� cn
— p
PIPE MATERIAL:
LOT SLOPE: LL'ts
REMARKS:
—. DATE APPROVED.
G.A.A.B.
Form No. EQ -031
Q
yiu�tnt 4
�°ratro nw�.l^%J
NAME OF APPLICANT
INSTALLATION LOCATION
LEGAL DESCRIPTION
GRE _R ANCHORAGE AREA BO
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
JGH rf3,
y RMI NO
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
MAILING ADDRESS .ice `PHONE
ellItr11r /"' /-/ / / r //i
INSTALLATION OFj
OEPTIC TANK jj SEEPAGE PIT
TYPE AND SIZE F FACILITY TO BE SERVE
DRAIN FIELD ER
A,
FINANCED THROUGH , TO BE INSTALLED SY
SOIL TEST RESULTS E: THIS PERMIT 15 NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL. QUALITY AUTHORITY WILL 13E SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE / "�//%- TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION 'f0 SEPTIC TANK
FOUNDATION TO SEEPAGE PIT `--v DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL -�
SEPTIC TANK 'y SEEPAGE PIT-"`, DRAIN FIELD
TO NEAREST LOT LINE.
SEEPAGE AREA SIZE � TYPE �—
DIAGRAM OF SYSTEM
WELL TO SEPTIC TANK v _. SEEPAGE PIT
DRAIN FIELD
ALSO CONSIDER AREA WELLS
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
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 SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL (BACKFILL
r
CONFORM TO BOROUGH HEGULATIONS REGARDING INSTALLATION../7
G.A.A.B.
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF
DESCRIB b SYSTEM IS IN ACCORDANCE WITH SAID CODE.
/ SC % G7
DATj /�' = ( �' APPLICANT'S SIGNATURE
h'
FOM NO. EQ -01 6
HORAGE AREA
NANCE-NO. 26-68 AND THAT THE ABOVE
-IMA -0
.�
FAIRBANKS
CONS UL'rAN'I'S, INC_ JUNEAU
249EAST 51ST AVENUE • P. O. BOX 6087 • ANCHORAGE, ALASKA 99503 • TELEPHONE 907-279-0463 • TELEX 090-35419
June 9, 1975
Clabo Construction
P. O. Box 3-4056
Anchorage, Alaska 99501
R & M No. 562045
RE: Test Hole and Soil Log Report for Sanitary System
Lot 3 Block 7 Kisiloff Hills Subdivision
Dear Mr. Clabo:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This
investigation was performed in accordance with your request of June 8,
1975, and those procedures outlined in a letter dated December 19, 1974,
by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department
of Environmental Quality.
A single test hole was put down with the Lot 3 area for the purpose of
defining general subsurface soil conditions for the proposed sanitary
System. Excavation was accomplished with a tractor -mounted backhoe and
the test hole was extended to a total depth of 15.0 feet below ground
surface. The final log prepared for the test hole has been included
in Drawing A•-01.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do
not hesitate to contact us.
Very truly yours,
R & M CONSULTANTS, INC.
W4
James W. Rooney
Viae -President
JWR/WED/sc
Enclosure
xc: GAAB
T. H, No. 1
6-5-75
0 0'
ti
w
ORGANICS
ORGANIC s
M--A�
v'u
00.
u �
SILTY SANDY
GRAVEL
(GW)
.0
�b0
o.d
3
o'0 0'
01.0
0 a:0.
0o0
0;
ozrj
SANDY GRAVEL
obo
�oo.o
TRACE SILT
(GW)
U'B6
O D' 0
PC!
00 ,60
00.-0
q0%,00
Q'd.o
8
GRAVELLY SAND
TRACE SILT
(SW)
b% b
No Water Table
Log Represents
Lot 3 Block 7
Kisiloff Hills Subdivision
M
IJ
3.0' T.D.
Clabo Construction
Jim Rhoads Property
Log of Test Hole
Anchorage, Alaska
�CC Consultants Inc.
(" ANCHORAGE FAIRBANKS ALASKA JUNEAU
IVL�
nnr 9— SCALE 1°=3' OWN eY MAR lcrtKo eY WED RROJ. No. 562045o�.vo No.
AB -HDI GRrP%TER ANCHORAGE AREA EORO" �H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING /���1y` �,{% r�/`t"� /
NAME_ V /7G _ADDRESS4'eli /G`�` t�J�� W PHONE
LOCATION UfrbGi ` LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE FROM WELL MATERIAL d�l
LIQUID CAPACITY _GALLONS. INSIDE LENGTH._
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL --
NEAREST LOT LINE
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES_
AB5. AREA_
DEPTH: TOP OF TILE TO FINISH GRADE
OUTSIDE DIAMETER
NUMBER OF
COMPARTMENTS
Kxlei `7c_ T [ f=i9-O',
_INSIDE WIDTH
Cf0, )6kC-FY
—OR WIDTH
. DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
FOUNDAT
ANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
TRENCH WIDTH
LIQUID
DEPTH.
heG(j 6 s
LENGTH , DEPTH ,
BUILDING FOUNDATION ,
SQ. FT.
DEPTH OF FILTER MATERIAL BENEATH T
TOTAL LENGTH
IN. TOTAL EFFECTIVE
IN. ABOVE TILE__
WELL:
TYP►EY ���--6:,7
/�
, DEPTH_
1-7d`
_,
DISTANCE FROM
BUILDING FOUNDATION.
/ /(
�I rp
WATER
SAMPLE-
NEAREST
LOT LINE /
NEAREST
SEWERLINE
SEPTIC�/ TANK
,�®r
'__,
, SYST ME
�g
CESSPOOL
— OTHER
DIAGRAM OF SYSTEM
DISTANCES:
e S�
,4 0
G 0
EG v 3y
619 = zLfl
GAAB•HD-? GREATEL ANCHORAGE AREA
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
"JROUGH
279-2511
SEWAGE DISPOSAL SYSTEM • APPLICATION & PERMIT
Case No.
NAME OF APPLICANT eVal'ren/ tL O _ MAILING ADDRESS aOX 401 . PHONE NO.— S�eti� -2Q3�I
�
RESIDENCE ADDRESS
LEGAL DESCRIPTION
LOCATION OF INSTALLATION
L o T 3 5 .k % K
o,,, ee 1 a
V U
APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT , DRAIN FIELD_,_, OTHER
TO SERVE THE FOLLOWING FACILITY. ._S-0 LaW—
FINANCED THROUGH ',-'>e L+ _TO BE INSTALLED BY SCI.
PERCOLATION TEST RESULTS ANTICIPATED ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS �'�� 8 PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
SEPTIC TANK SIZE /��W9 TVDC `Too / ec�DAr-c ADCA � TVDc &u -
DISTANCES: I/nik
c%
)JL4tv
Health Authority
I certify that I 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.
C�
DATE G� %�� _�. APPLICANTS SIGNATURE
.REATER ANCHORAGE AREA BOR000H
HEALTH DEPA1,7MENT CASE fl
327 EAGLE STREET
ANCHORAGE, ALAaKA 99501
Performed For A,0//) Date Performed
Legal Description: Lot _®B1ock�.Subdivis ion -e({�SrJ�-:
This Form Reports a: Soils Log ircolat).on lest
Depth
Feet Soil Characteristics
Gross Time Net Time Depth To H2O
Net Drop
sho ues� a budlter,
tl
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Was Ground Water Encountered?
If Yes, At.Y,hat Depth
7-7
Reading ^ate
Gross Time Net Time Depth To H2O
Net Drop
,
Prop)sed Installation 'Seepage Pit i Drain Field
Depth Of Inlet .�" �f -P —""`-"."a^-m•.,—,4•;-
Ll/�/i ��iuf� Depth To Bottom Of Pit Or 'French
COMMENTS: „, _
Test Performed By-.
r�
Data Certified By:
I
M -W DRILLING, Inc.
P. O. Box 4-1224 • 1310C International Airport Road
(907) 274-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner----- LJse of Well_-'
Location (address of: Township, Range, Section, if known; or distance main
Size of casing - -Depth of Hole— - feet Cased to ) feet
Static water level ft. (above) (below) land surface. Finish of well (check one) open end
Screen ( ); Perforated ( ).
Describe screen or perforation
Well pumping test at_ - gallons per (hour) (minute) for hours with— "'' ` ft.
of drawdown from static level.
Date of completion --
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
TOi-------
- TO— 7
TO— i - ,r _ c
TO- _.—
I,\' 7A Certified Contractor
Certificate No's. 814 &- '
r0 _ MUNICIPALITY OF ANCHORAGE -
- �SE7..-0F Hl!ALTH &—
ENVIRONMENTAL PROTECTION
TO—
TO---
O TO - - --- - AUG 3 01988 -
--- TO-- — R1 1 V)
TO-
o
TO -
To
3 — CONTRAC'TOR
3—CONTRACTOR
Parcell.D.
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904 e^ F*
��(✓ �SSv ca17C�
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
5-161-12
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
Expiration Date: � ` q— I
KASILOF HILLS: BLOCK 7, LOT 3
10841 STROGANOFF DRIVE `ANCHORAGE, AK
CONRAD BAGNE Day phone
10841 STROGANOF DRIVE *ANCHORAGE, AK
2. TYPE OF DWELLING:
■ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
!ARi1»�7�4'/3i�;�Y�1»Ail
Day phone
346-2618
TYPE OF WASTEWATER DISPOSAL:
Individual Well
M
Individual On-site
■
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for. N/A Distance: -
Received by: Date:
COSA to be released to the engineer, unless othemise requested by the engineer.
COSA Fee $ �J Zi0
Date of Payment
Receipt Number 02-0-2-1 r 6
COSA # TSG 15- I 7 C_
Waiver Fee $
Date of Payment
Receipt Number
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.
Address 3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, AK, 99507
Engineer's Printed Name
Engineers Comments:
JEFFREY A. GARNESS, P.E.
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 systemis on the datels of the evaluation. Separation distances were measured to readily identfiable features.
Hidden defects or encroachments may exist that were not identified dunng the evaluation. The operational life of all wells and septic
systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate acting
the yea/i, quality of construction (matenals and workmanship), and the water usage of the family utilizing the systems. These
conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
systeMs; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septc 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 The content of this report is for the sole benefit of the personparty who retained GEG. Reliance upon the
information provided in this report by any otherperson or party, including but not limited to subsequent property purchasers, is not
authorized. In short, GEG disavows any legal duty to anyone other than the persoNparty who paid for this report.
6. DSD SIGNATURE
System #1 Approved for 4 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms,, with the following
Phone 337-6179
Date tZ b`f /
.Htu.aoe
i'\llllllll(t/j
OF��r�O
ON-SITE
WATER AND
'VrkmiZOrWASTEWATER oz=
sc9 PROGRAM
Original Certificate Date: I Z `1
The Municipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist l Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
ra=„ mn�nm
t
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: KASILOF HILLS. BLOCK 7, LOT 3 Parcel ID: 015-161-12
'PER MOA RECORDS, THERE WAS ALSO A WELL ON THIS PROPERTY IN 1969 THAT WAS 170'
A. WELL DATA DEEP "246' PER 7/8/1975 WELL LOG, BUT 214' PER AAROW PUMP AND WELL INSPECTION IN
2015 (SEE ATTACHED RECEIPT)
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed '7/8/1975 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth "246 ft. Cased to 21 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 7/8/1975 - 7/24/2015
Static water level 100 ft. 71
Well production 3 g.p.m. 1.8+ g.p.m.
WATER SAMPLE RESULTS: 1) t
Coliform colonies/100 ml. Nitrate"' T g./L. Collected by: GEG, Ltd.
Arsenic: t Lug./L Date of sample: 12/7/16
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 7/2004
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N)NO_ High water alarm (Y/N) N/A
Date of pumping 12/12/16 Pumper NORTHLAND PUMPING SERVICE
C. ABSORPTION FIELD DATA BELOW EXISTING GRADE
Date installed 7/2004 Soil rating ( .p.d./ft r ft'/bdrm) 12 System type DEEP TRENCH
Length 40 ft. Width 2 ft. Gravel below pipe 7.5 ft.
Total depth "15.47 ft. Eff. absorption area 600 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 7/24/2015 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth, in absorption field before test 6 in. Water added 761 gal. New depth 111 in.
Elapsed Time:" 130 min. Final fluid depth 7 in. Absorption rate >= 600+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
0
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at ligh 111i"JIIIIii alarm level at - in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots. 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer /septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption fielc
Water main 101+ Water service line 10'+ Surface water
5'+
100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 1 10'+ Water main 101+
Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
DRAINFIELD IS ABOUT 5' FROM SLOPES >25%. NO DAYLIGHTING WAS OBSERVED AND ENCHROACHMENT HAS
EXISTED FOR 11 YEARS; THE BANK IS SHOWN ON INSPECTION REPORT HOWEVER NO WAIVER WAS REQUESTED.
G. ENGINEER'S CERTIFICATION
I certify that 1 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.
Engineer's Printed Name JEFFREY A. GARNESS
Date 12 11 Li 6
(Rev. 10/12/12)
2
LICENSE♦,4���"S`�'
#AECC884
u
9
-� <.� big "` i 2.
Municipality of Anchorag ti Ha
On -Site Water and Wastewater Program ZD�J'_
(907)343-7904 d OCT 16
�y6 w
Certificate of On -Site Systems Appro « OL
8 9C5A
Parcel I.D. 015-161-12 Expiration Date: t ' t
1. GENERAL INFORMATION
Complete legal description KASILOF HILLS; BLOCK 7, LOT 3
Location (site address) 10841 STROGANOF DRIVE *ANCHORAGE, AK
Current Property owner(s) CONRAD BAGNE
Mailing address
Real Estate Agent
Day phone 346-2618
10841 STROGANOF DRIVE *ANCHOAGE, AK
SARAH HALTNESS
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
Individual Well
19
Individual Water Storage
❑
Community Class _ Well
❑
Public Water System
❑
WaiverNariance request for:.
Received by:
Day phone 261-7682
TYPE OF WASTEWATER DISPOSAL:
Individual
19
Holding Tank
❑
Community
❑
Public Sewer
❑
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 624y —
Date of Payment !O%/ 9 1/6-
Receipt Number o .)-62-q 6)
COSA# t 5(_1/6 5?�4
Date:
Waiver Fee $ _
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal'dffixed 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. Phone (907) 337-6179
Address 3701 E. Tudor Rd., Suite 101 Anchorage AK 99507-3246
Engineer's Printed Name Jeffrey A. Gayness Date i D 1 b )is -
In
t3
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 industryprecu'ces. The reported results describe the condition of the systems
on the datels 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 on 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 systems; 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. The content of this report
is for the sole benefit of the persoMparty who retained GEG. Reliance upon the information
provided in this report by any other person or party, including but not limited to subsequent
property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other
than the persoNparty who paid for this report
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for
Disapproved
Conditional approval for
M
bedrooms
bedrooms, with the
0N.S1 P p
W S E PCE¢
W PROGRPM .
Original Certificate Date:—T-- 3
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
COSA blue sheet_94-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # of
S'Lructure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: KASILOF HILLS; BLOCK 7, LOT 3 ParcellD: 015-161-12
GPER MOA RECORJ2S, THERE WASALSO A WELL ON THIS PROPERTY IN 1969 THAT
A. WELL DATA
WAS 170' DEEP (* 46' PER 7/8/1975 WELL LOG, BUT 214' PER AAROW PUMP AND
WELL INSPECTION IN 2015 (SEE ATTACHED RECEIPT) YES
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N)
Date completed
0 7/8/75 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total dep146 ft. Cased to 21 ft. Casing height (above ground) 12+ In.
FROM WELL LOG AT INSPECTION
Date of test 7/8/75 7/24/15
Static water level 100 ft, 71 ft
Well production _ 3 g_p,m. 1.8+ g -p -m"
WATER SAMPLE RESULTS:
Coliform 0 colonies/1 00 mi. Nitrate 0.554 mg./L. Collected by:_GEG. Ltd.
Arsenic: ND ug./L. Date of sample: 7/24/1
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 7/2004
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO . High water alarm (Y/N) N/A
Date of pumping 10/6/2015 Pumper MCDONALDS
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE AT MT
Date installed 7/2004 Soil rating (g.p.ddit or /bdr 1.2 System type DEEP TRENCH
Length 40 ft. Width 2 ft. Gravel below pipe 7.5 ft,
Total depth *15.4 ft. Eff. absorption area 600 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 7/24/15 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 6 in. Water added 761 gal. New depth 11 in.
Elapsed Time: 130 min. Final fluid depth 7 in. Absorption rate >= 600+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YM) �—
"Pump on" level at in. "Pump off level atm—;Hater alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer /septic service line 25'+ Holding tank `js'
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM 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'+
SEPARATION DISTANCE FROM 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 NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
DRAINFIELD IS ABOUT 5' FROM SLOPE. >25%. NO DAYLIGHTING WAS OBSERVED AND ENCHROACHMENT
HAS EXISTED FOR 11 YEARS; THE BANK IS SHOWN ON INSPECTION REPORT HOWEVER NO WAIVER
WAS REQUESTED
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.
Engineers Printed Name JEFFREY A. GARNESS
Date 1410.1lS.-
(rev. 11/05)
06/23/2015 21:12 907-345-0202 ALPINE DRILLING PAGE 01/01
� � � i i , {r ,
AAROW PUMP & , EIC SERVICE, LLC I f p1p 2
�UUV®Q�S
P.O. Box 110496,
Anchorage, AK 99511 NO. 10500 :,.;:
Office: (907) 346-9355 • Fax (907) $45-0202
Fagle. River; (907) 622.9935
JOB SITE
L
Ke INVOICE DATE
1
J. L.
ED PUMP
:1veT10N
,.:..;.PRICE �{
F?.
LABOR HOURS RATE AMOUNT TOTAL MATERIAL
TOTAL LABOR
WOR
K:ORDERED BY :,;. .TOTAL,' ,.
LABOR.
PAY THIS AMOUNT
rhank.You ,
ti; SIGNATURE t
(I HerebyP.cknowledge tha'Satlslaetory Completlon off t e. Above Described Work and agree that If above work is not paid for in 90 dayg I ag1'ee4o allow. garow'
Purllp &Well Service, L.L.C. the right to'remoUe unpaid for equipment and'gharge for Ichor already performed& labor to remove unpaid for equipment.)
TERMS ACCOQNTS PAYABLE AT 10TH OF MONTH*OLLOWING PURCHASE. r
SE�iVIC�'CHARGE AT RATE OF,"
.5% PER MONTH WILL BE`CHARGEO ON OVERDUE ACCOUNTS
I
STROGA&oFD IVE —
NORTH 13e.eG.
MUNICIPALITY OF ANCHORAGE
• �/ DEPARTMENT OF HEALTH & HUMAN SERVICES 01114-A
_7 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. t.lc - 'i _ HAA It —144YL:)�
1. GENERAL INFORMATION
Complete legal description -v� 3F 64'clv- 7 fz -flof Elft((
Location (site address or directions)
.S ro qnn of Dr.
V
Property owner rrsn,--�'
C 4 -S -11e Sar e Day phone 3y6'-261'
Mailing address (o6'r1 SAYvna,f' 6r-.
Lending agency Cc AX "or V 7e_ Day phone
Mailing address q5 W. 36"'
Agent N, A. ( � �/�A.1cc�_ Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well r/
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA P21
5.
6.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm r -Ya /-/vn 7"edh n e'ca! S'ervi cev Phone 3 YS- 35'.S- _
Address /V,, 34 A�5—clte SA ho ciiar Ak 995-(t<
Engineer's signature r — 5 �%?�tad� Date 9/
DHHS SIGNATURE
Approved for
Disapproved.
,�i ,ee.eeeeeo�ae 't
(J.
Atte v bedrooms.
Conditional approval for
Additional Comments
bedrooms, with the following stipulations:
By:
C _ / !- Date
1ufle,
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA 1121
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 1-3/ & 7, CA.1rtof 41f(f Parcel I.D.
A. WELL DATA
Well type Pr1v 011 a If A, R, or C, attach ADEC letter. ADEC water system number — Mrd•
Log present (Y/N) Y Date completed 7 /St' 7,S" _ Driller_ M 4 u✓
Total depth 2yo Cased to P/ Casing height J9 it
Sanitary seal (Y/N) r Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
%/7r
too
AT INSPECTION
q1 es -
63
g.p.m. 2.2
¢.
2�J r
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot _1'2o ' 7'0 C. (7• — ; On adjacent lots
U
to c
a V
sv
1C
g•p.r >
Z3 C)
m
K.cc�
<D ci
m
Absorption field on lot 15-0 t A7 C•0• ; On adjacent lots > (go '
Public sewer main > (0a' Public sewer manhole/cleanout _ > 100'
Public sewer service line N, A, — Petroleum tank __Mone Ce-ee)
:�5• I'imi
Mn
C�7
C4N7 r—rI
WATER SAMPLE RESULTS:
Coliform o I tao me Nitrate 1. Other bacteria a / 100 M --e
Date of sample: 'y/?_ l 9/ Collected by: x"•_774' -
B. SEPTIC/MOLDING TANK DATA
Date installed i // ti / 7S_ Tank size l 2S i) al Compartments
Cleanouts(Y/N)
Foundation cleanout (Y/N)
High water alarm (Y/N) 1V,A. Alarm tested (Y/N)
Date of pumping .5'13 01 16y _Ztctaer
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Depression (Y/N) N
N.
Well(s)onlot 120` Ffv_m C-0• On adjacent lots -:;w ec-pcd' Foundation 26"
To property line Absorption field W Qeitu Water main/service line _
c•.a S
Surface water/drainage %
C. LIFT STATION N.A.
Date installed Manufacturer
Size in gallons P#=3FV Manhole/Access (Y/N)
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
'Pump off' level at
Cycles tested
Surface water
Date installed ��f`/ ?S Soil rating Its 0'lr3drlll System type
Length 1 Width 17 Gravel thickness 6 Total depth
Total absorption area K 20 Cleanouts present (Y/N) `r
Depression over field (Y/N) N Date of adequacy test SZ 3 /9 /
Results (pass/fail) for 3 bedrooms
Peroxide treatment (past 12 months) (Y/N) N If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1S0' On adjacent lots > too —Property line
To building foundation To existing or abandoned system on lot 7 30
On adjacent lots ';> 30 Cutbank
Water main/service line 90'
Surface water i tvo I Driveway, parking/vehicle storage area
Curtain drain Sean
E. ENGINEER'S CERTIFICATION
2s"'
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
T f P
Signature
�r/_e O�j�(�� L _/ ,ne /p P_' �o0�
Engineer's Name �� //��
ilxo��.o ao,+oa n o u v o p a 5 a oeoo
5-06' /9
pooeca seeoa ao ocou aap oF:
y �n�eo�o;,�
Date /
tI. _ � r.
0
0
174- © co
HAA Fee $
Waiver Fee: $
Date of Payment �' 1 C Date of Payment
Receipt Number 7iZ� l �` ✓� Receipt Number
79_n9R 1p— 1/011 Gen. AA1n �
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING
5633BSTREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)562-2343 FAX: (907) 561-5301
17 F
A 11 P 1. L I',, M.TFi li7 : I'llp,
PIPBiNICIPALI T Y OF ANCHOIFIAGE
i,„3;es;i:rb ri; r14Af_rll AND ENVIRONMENTAL I'Io'TI1I10a
,jiViSitir'A OFENVIRONMEN T Al,. HEALTH
;f.! f( 1 ;ij rL O; Ipl;,'L.G'i ION FOR HEALTH AUTHOP,ITY APPR"VAL
F OPd. Sl f'r. SEWER AND WA I ER FACILITY
t 264-4720
I
>,. Application Date
ciude lot, block, subdivision section, township, range)
3-10 !_7 KasiIo.r Hills Subdivision_ Sec.-OonJ3T.--L' N--L—k __M42
.ha A°l L' ^I Name «dtpP S_-�,� f��108d� - - Telephone: I -tome 346-M5 _ Businessd.--
d`
13 (Ch.cjck on-). Lending Institution CI : Owner/builder L1"'Buyer F) : Ott (explain);
Telephone
1
l�
(e) Real -ta;'; Cr !-,parry and Agen: ----.
Addre-
fi i��ast tic 11Ai.'n�rye following address:
2. TYPE OF RTSIDENC E
Single-Farnry (;al t,?u!U-f=amily Other
Number of Gedroom� - 3——_.-—__---
WATErl SUPPLY
Individual VlefhO omrnunity [l Public C-1
Note: if corrrnunity v.�i! system, roust have written confirmation from the State Department of Environmental Conservation
attesl-ing to `;,.G ',-•L- '.y and status.
4. SEWAGE DISPOSAL
On,,ItPA—YJ Pe� -r ❑ Cornrnunity E7 Holding Tank U
Note If r,r,rr.rrJ_ :qty V,r- system, ruj t have, wr'I [ten confirmation from the State Department of Environmental Conservation
taehng fo tie le, -,'illy acri st:iur:
Psi' , 'I of `l.
AM
5. '"F'>(#a UE€ RING RAM PROVIDING INSPECTIONS, TESTS, FILE 5E;APICH, DAT A AND I fE pit
f ,c€:'afied t y my ,eal affixed hereto and as of the validation date shown below, I verify that my invc,[i<i gs',
Ae!tr?G;¢(iaar,rr o;vsthat (heon-site water supply and/or wastewater disposalsyster(llssafe, 1k,1, rr,;,,._Ifor tht- r ,nh= r of be droorns and type o structure indicated herein. I Iurt(ior verify that based on the inforn
"rrjrrt Shy f"unic!p�rr,y at Anchorage files and from my investigation and inspection, the on-site water ,
wa�te,w<jxr di ;;rsal sy tern is in compliance with all Municipal and State codes, ordinances, and regulauor,;,;r
fate dat c,f to in:r e t nri.
4darrer;=rtes __iJ!jA1RQ,_,_ ENGINEERING INC° -Telephone _ 907 27 -3770
---- - F401 . F'irEMCC(l_l-ane, Anchorage, AK 99503-21-97 - - —
UatO
Lngincers Seal
e¢a00 o00o onuV woo'�a o°+��--' -�
Michael E. AnucrSon +,`
4331
e00oa,00en����r'
U ral-ff_P Arae R 0 V A L� i v
bedrooms by Date
Disapprove _.__—_- Conditional - _-- --
TersT+ ;` l:nr; .,,.,.; Approval
CAUTION
Thr, !/.:n : ry rf /-.r,r horago, Department of Health and Environmental Protection (DHEP) issues Health Authority
Appr�r:c) ce i`,rarrs bs,ed solely upon the representations given in paragraph 5 above by an independent professional
r•n :ir,: qr rr. :; r ;%++,;, th, j "tate of Alaska. The DHEP does this; as a courtesy to purchasers of homes and their lending
it titctior_� .o �r;r:r to sats,f y certain federal and state requirernents. Employees of DI -IFP do riot conduct inspections or
a r_rrr f r;atc. is iSSued. The Municipality of Anchorage is riot responsible for errors or omissions in the
:rork.
r°
MUNICIPALITY OF ANCHORAGE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
AUG 2'1 ' I
RECEIVED
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: Lot: 3v 61 k. 7,
Kasilof Hills Subdivision
Well Classification individual/private If A, B, C, D./E.C. Approved (Y/N)
Well Log Present (Y/N) Y _ Date Completed 77M.&� —Yield 9.0 gal./min,
Total Depth 240 ft. _ Cased to 'v� Depth of Grouting none
Static Water Level 48 ft. Pump Set At ZZ011
Casing Height Above Ground 1.5'
Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) _Y
Separation Distances from Well:
To Septic/Holding Tank on Lot -120' _ ; On Adjoining Lots 175'+
To Nearest Edge of Absorption Field on Lot 150 —; On Adjoining Lots 115_1+
To Nearest Public Sewer Line N/A To Nearest Public Sewer
Cleanout/Manhole _)A To Nearest Sewer Service Line on Lot 95'
Water Sample Collected by A. Haral a ; Date 8/15/85
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 6/78 Size 1250 gal- No. of Compartments _"
Standpipes (Y/N) Y — Air -tight Caps (Y/N) — Y Foundation Cleanout,(Y/N) Y
Depression over Tank (Y/N) _ N _ Date Last Pumped t/ /
Pumping/Maintenance Contract on File (Y/N) _ ; for
Holding Tank High -Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well _ 120'
To Property Line 58'
To Water Main/Service Line
Course N/A
Comments
Page 1 of 2
'+
Temporary Holding Tank Permit (Y/N) N/A
To Building Foundation 26'
To Disposal Field 34'
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 125 ft.2/ Bg Type of System Design Seepage Pit
Date Installed 7/75 Length of Field 181
Width of Field 17' Depth of Field _ 6
Gravel Bed Thickness
Square Feet of Absorption Area 420 Standpipes Present (Y/N) Y
Depression over Field (Y/N) N Date of Last Adequacy Test 8/15/85
Results of Last Adequacy Test satisfactory
Separation Distance from Absorption Field:
To Water -Supply Well 150' To Property Line 20'
To Building Foundation 48' To Existing or Abandoned System on
Lot N/A On Adjoining Lots 125'+
To Water Main/Service Line 85'+ To Cutbank (if present)18'+
To Stream/Pond/Lake/or Major Drainage Course N/A
To Driveway, Parking Area, or Vehicle Storage Area 25'
Comments
D. LIFT STATION
Date Installed NO LIFT STATION Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certifythat
II havechecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Q,GLdC✓L3ftrrte4/g1/cq
Company 01'"/LA CNGiiJ�7Qa6 MOA No.
Receipt No. H) r%. AI
Date of Payment A �,'V's
(�
ew c? °t
Amount: $4r�Engineer's Seal
I g � q•..•eao.o.::L��
'0 41 E. Andersun':':...':'
Page 2 of 2 ip 4381 .a a 3
p �
7z-ozsiwsat:. ��®Ao�ESSIONP""
4,M �.. FO iEXl([4fP) kANA_
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4,f')7,) �7kr.307A
� Pill
—
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7 •' 34 �/tiD iY�i': //!{/�e�/pig
1/0 -�
D ,V
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i%?57C j_&elV,!FZ—
Z- ✓
ell r
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13 7-
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9p_4?
---
CALCULATE -k) BY . 5 - --
CMECKMe
SOALF
ve�
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
DIRECTIONS: Complete all parts on page 1.. Incomplete requests will not be processed. Please allow ten. (101 daysforprocessing. -
1. PR
p�O..�dhc
Y3.4 Ile,
PROPERTY RESIDENT (If different fro above)
PHONE
2. BUYER r �'�
PHONE
MAILINGADDRESS
-
3. -LE—DING INSTITUTION
MAINDFi $$,/�
4. REALTOR/SA�GGEE�NT
MAILING ADDRESS
5. LE L DESCRIPTION
STRE4.O `—L 00
-- - _
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
SINGLE FAMILY ❑ One ❑ Four ❑ Other
O Two ❑ Five
❑ MULTIPLE FAMILY Three ❑ Six
7. WATER SUPPLY - -
INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
0 COMMUNITY since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY depth (attach log if available.)
B. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date��_
If system is over two (2) years old an adequacy test is required
ED PUBLIC UTILITY by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN 13E INITIATED.
72-010 (Rev. 3/78)
THIS SIDE FOR OFFICIAL USE ON,
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME
TIME
TIME
DATE
DATE
DATE _
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE
❑ TWO
❑ THREE ❑ FIVE ❑ OTHER
❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON-SITE
E--1 PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER - -�
�eptic Taak or ❑ Holding Tank
Size: 0- If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTVIJER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
Lit' APPROVED FOR 'f BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
�(i
.�-�6- �l
BY (Title) C
- \
�g{��/,/���/
.YP'_
LEGAL DES���CiiiRRIIPTION
72-010 (Rev. 3/78)
MUNICIPALITY OF ANCHORAGE
f
l�! �i �`v f�a
DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTECTION
d /
- - - 825 L Street - Anchorage, Alaska 99501 - - - -
-
ENVIRONMENTAL ENGINEERING DIVISION
NUMBER OF BEDROOMS
Telephone 264-4720 -
ED One F - Four ❑ Other
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow; ton (10) days for processing.
1. PROPERTYOWNERPHONE
�yY—'7
., f Al O��a o S _
9-k
MAILING ADDRESS
S/1/7 A01Gry Va C{ ,/
since June 1975. For wells drilled prior to that date; give well
PROPERTY RESIDENT (If different from above)
PHONE
2. 13UYE11_ : - �-
PHONE - -
MAILINGADDRESS - - - - - - -
- -
3. LENPING INSTITUTION' --
(& -5 A-: IAi f,7-(/ 1Y V.,r)-- S- el ?vf
PHONE
MAILING ADDRESS
by this Department. :
jVeaf60 //00
�;
4. REALTOR/AGENT��
PHONE
MAILING ADDRESS
S. LEGAL DESCRIPTION v��
4 oT � / e9/
f
l�! �i �`v f�a
1 �"i
d /
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
k SINGLE FAMILY
ED One F - Four ❑ Other
El Two ❑ Five
EJ MULTIPLE FAMILY
X Three0 Six
7. WATER SUPPLY
INDIVIDUAL*
* 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 UTILITY
depth (attach log if available.)
8. SEWAG E DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
**If individual/on-site, give_ installation date—,�.
O
If system is over two (2) years old an adequacy test is required
PUBLIC UTILITY
by this Department. :
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
r
�;
THIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS: -
1. TYPE OF RESIDENCE
LSINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
E:1 ONE C THREE E] FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified_LOG
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
RECEIVED -
3. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON -SITE
__PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK -
MANUFACTURER -
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL T0:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate) rye
❑ DISAPPROVED
/ti(/. -f' (/c C S �✓ �'h;T
DATE BY (Title)or 13
LEGAL DESCRIPTION
72-010 (Rev. 3/78) \�j
®
R&M CONSULTANTS, INC. 5o24 COROOVA 11 BOX 6091 n ANCHORAGE. ALASKA 9956: o PH ' 07 2]9-0183 B TLX. 090 253110
E.NGINF:ER.^..
GEOLOGISTS
VLANNERS
lULIVEYORS
May 22, 1978
Debbi Johnson
P.O. Box 1120
Alaska Mutual Savings Bank
Anchorage, Alaska
Attn: Jim Rhoads
R&M No. 851523
Re: Adequacy Inspection and Water Well Sample for Lot 3, Block 7,
Kasilof Hills Subdivision, Anchorage, Alaska
Dear Ms. Johnson:
Per your request of May 19, 1978, we performed an adequacy inspection of
the sanitary septic system and sampled the well water on the above des-
cribed property. The 3 bedroom dwelling on the property has a sanitary
sewer system located on the west side of the house. Three standpipes were
visible at the approximate locations shown in diagram A-01. A surface
inspection of the system showed no visible evidence of seepage indicating
that the system is apparently functioning properly. A water sample was
taken in accordance with the Department of Environmental Conservation speci-
fications and delivered to their laboratory for analysis.
We appreciated this opportunity to be of service to you. If you have any
questions, please don't hesitate to contact us at any time.
R&M CONSULTANTS, INC.
Lynne Kosikowski�m�
Staff Geologist
LK, JMB/pat
Jim McCaslin Brown
Project Manager
ANCHORAGE FAIRBANKS JUNEAU VALUCZ WASILLA
DWN.
CKD. c%ye F1& M CONSULTANTS, INC.
DATE. S"-.Z�?-TB ENOINEEP9 GEOLOGISTS PLANNERS SURVEYORS
SCALE. /V7 -:f,
-7. 5 ' achy T
20�5�
a�Pric rN�1K
35'
ca�B
GOTS FB.
GRID.
PR0J.N0.85.16WJ
Sr✓.( jJ.�✓{.'P.FJ��.% DWG.NQ 4-0/