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�� � / ' 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 �er'c[r,irr.�e a ?/ u r°i,d s , Sr�{ /Gar X9-5 , Gs, s'hocuns ue1, iell, eloL e.or,iei,i, The Sr Jl GI/)d pP,'C-cin /61C/ E' 5'fiq /� lvc� Jinn Gm� Guj r-!'7 C!/J 061sf--s //l/f ,S /o�c/'• 7Liere is c,�prox;mc,ie��. /dX- r5 roc l; G<,J a //i er-wise tlresc sedlv�irrrrl3 e��nu/<l Gam' Ice 4 clvssPi as a til%.,e s� 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_ AAWW)Okcs, NLAkM 99fr (Ori» 4,f')7,) �7kr.307A � Pill — �u�Stk�ir!�D�4'sl'�� @m�s�W,R;r,- 7 •' 34 �/tiD iY�i': //!{/�e�/pig 1/0 -� D ,V z // i%?57C j_&elV,!FZ— Z- ✓ ell r i O ,/1G`ly 13 7- 1(2,7,,9 % z� / - 3rz z // A mRR w@r +i&"W-,M KAM0,»# wp 2&W7# 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/