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HomeMy WebLinkAboutGOLDEN HILLS BLK 1 LT 3Golden Hills Block 1 Lot 3 #015-122-29 (Rev 05/02/18) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221194 PID Number: 051-122-29 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name LORI & JAMESON CAUDY ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 10101 GROVER ST, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot GOLDEN HILLS 1 3 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Half of the tank is insulated. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer N. EX Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1" 9/7/22 nd 9/8/22 Location and description 3`d 4'h BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF A ' Conditional Approval: Date ��Q'�`. • ' . �,� �� • • Curtis " Huffma""n Septic System roved - r� � -22— Z Date[a- CE 128991 �� f��•. 12/13/2022AGW •��G ll`F�pROFESS10NP Note: this approval does not include well permit requirements. (Rev 05/02/18) PID: 015-122-29 1 PERMIT: OSP221194 BM: BOTTOM OF SIDING FCO H co A—C=16,4' 98.50 B—C=43,2' A—D=20,0' 94.50 B—D=44.7' ON A—E=21,8' 939 HDPE SEPTICC B—E=45.2' TANK GOLDEN HILLS BLOCK 1, LOT 3 PREPARED FOR: LORI & JAMESON CAUDY 10101 GROVER STREET ANCHORAGE, AK 99507 FIRST WATER CONSULTING GRADE INSULATION SEPTIC SECTION SCALEI NTS 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK©gmoil.com Easement S89°5 EXISTING FIELD SUPPORT® SERVICE � o . DATE: 12/13/22 SURVEY: ELW DRAWN: FWCS SCALE: 1 " = 30, MT/SUMP OF AZA A00�'c' v� 9 TH rtis Huffman CE 128991 �`� 12/13/2029 ��ssioK�' ~W 8434F � I Lot 2 E-- IU x10' Utility Easement �7 V C� 9056 f40"E 281 .29 0 Ww ,Septic vent V —1 0 Q5 17 Lr) reo y, ` r2.0 OH Ref. all (typ}-- ~`J @ 0 ^R' oWell Septic vents--'' o 4 a ^ 263 v?Manhole CO--)� 3 Story Frame �0•$ ^ House^ C) 11.0 p• i• 4 , ) a@ Ra, *) ( `Chain link fence Lot 3 I Z W �- Z`,r -11 :W1 W _ W :2 d z W Iw 0 tom• < N 0 LU( 0 C) o C) o —J I CD C> i=- a z o 0 00 Z CD 10' UTILITY EASEMENT I Lot 6 S89050'40"E 331.90 Lot 7 Hillside Park PU6 Subd. RECERTIFIED 11-11-22 AS -BUILT NO CORNERS SET THIS DATE OF • A< 9 1 hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following �Q . ' • • ' gS,rr �� described property:_ LOT 3, BLOCK 1 Ui • 49th '•_-p GOLDEN HILLS SUBDIVISION 00 • $ 0 Anchorage Recording Precinct, Alaska, and that the 00VIrizabeth improvements situated thereon are within the property lines • and do not overlap or encroach on the property lying 4t �L. Walatka . ,o ,/r adjacent thereto, that no improvements on the property lying �, adjacent thereto encroach on the premises in question and 4 ��� • • 8036 – LS • • J6�� that there are no roadways, transmission lines or other �Fp ' . • , o �_� visible easements on said property except as indicated „_ , �d �a�£SSIONAL•��"� hereon. = SCALE: 1 50 a Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN this 14th day of MARCH , 2016. THOSE SHOWN ON THE RECORDED , r FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON FB 22-4, pg 22Engineers and Surveyors BE UNLESS OTHERWISE NOTED. FB 16-1, pg 23 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. MU Nl CIPALITY OF ANCHORAGE On ke Water $ Wastewater Program M 5W 195650 47CC EL•narc Rrad Amharage•Alaeka9%19 % Pn;)1ie: (9D7) 343-7504 Fox; i91)7� 342,790 hup:f w m.murri.0rgronslk- O n ite Wastewater Disposal System Permit Permit Number: 0 -SP 1194 Work Type: -SepticTank Upgrade I ax (;Qde plumber: 01b12229000 Site Legal Addnms4t GOLDEN HILLS ELK 1 LT 3 G:2539 Site Malling Addm:ss: 10101 GROVER 5T, Anchorage Owner- GAUDY J MESON L & LORI A Design En!y1kie-L%r_ FIRST WATER CONSULTING This pormit is for the construction of, Effective D : Explratlon : nt X ti t i�•��,�I'�rut•ri4 Loot Site In Sq F#: Total Bedroomm 6321)22 6f2M023 6612$ ❑ D ispusa I Field m Septic Tank ❑ Holding Tank 0 Nvy+ ❑ Private We II ❑ Water Storage All co struotilo 1 shall be in accordance with: 1. The attached apprav-&d design_ 2- All requlremenis specified in Anchorage Municipal made C Iiapters 15.55 and 15,60 a rt4 the State or Alaska Wastewater ❑i5po5al Regulalions (I8AAG72)-and drinking WaterRegrJloilorls �15AAC60} 3. The waStewate r code reauires Insneelion s during the inMR11IR16nn. The r3nginp.er a: h FkII nrAifV 1h* rliwwodrir rmpnr Services Department per AMC 15.65. Rraalde nollflCcktlor1 I>y Calling (907);343-7904 (24,8)- 4. From Ocb*or 15 to Apfil 15, a subsurface soil abaarption syslem under uon:strurrtiuri dodrig freezing weather shill be either: e. 00ened and Closed on the same day, or b. Covered, sealed, and heated to prevantfinezln9 Received By. lssuod W412 Data; Date; - C 2 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-122-29 Property owner(s) LORI & JAMESON CAUDY Day phone Mailing address 10101 GROVER ST, ANCHORAGE, AK Site address 10101 GROVER ST, ANCHORAGE, AK Legal description (Sub'd., Block & Lot) GOLDEN HILLS BLK 1 LT 3 Legal description (Township, Range & Section) Lot Size 66,129 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank Q Upgrade nX (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 4a a5 Date of Payment:�13 1 1 a 0 a Receipt Number: 0,1-3105 Permit No. 0 S Pa a 1 19 9 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewate r\Forms\C lie nt Forrns\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com June 13, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: GOLDEN HILLS BLK 1 LT 3 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221194, Rebecca Carroll, 06/23/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221194, Rebecca Carroll, 06/23/22 A--- Q._...,C011100r"L Alaska state law requires that a copy of this well log be sent n) the Department orNatural Resources within 45 days: fixes are acceptable. (AK statutes 38.05.020, 38,05.035.41.(18.(12(L 46.15.020 and AK regulations l l AAC 91140)• DNR/ Division of Mining, Land and Water, 5.50 W 7th Avenue, Suite Anchorage, AK 99501- 3562 Phone (907)269-8639 and fax (907)269-8947 Within the City of Anchorage, it is required that a copy of the well log be sent to the appropriate city office within 60 days and that another copy of the well log be sent to the well/property owner within 30 days. Permit Number: OSP131078 Date of Issue: _EeU,j /2oj 3 Parcel Identification Number: Is well located at approved permit location' ( X) Yes or ( ) No ec `4-e�y Di i(ffng, 'Inc,-� DEPARTMENfOFNA DIVISION OF MINING, LAND & WATER lval t 1-t'; II 2't r•Viiu) ,tad `i^tn tet Srnaic WATER WELL LOG i Drilling Siarted3_1__4_,2M Completed ,_3_j_Z/ 7018 City/Borough: Sabdivi$ion: BLOCK LOT Property OnmcrNameStAddressc WeslieandfVlarleneTindell 10101 GrovelAnrhnrPgeSt. Anchorage Golder Hills 1 3 Meridian I Towoahip Range_ Section _,--'/4 of n/a of % of _ '/d. BOREHOLE DATA($orri top of caSing)Depth Drilling method: (X) Air rotary, ( ) Cable tool, Other_ Material: Type, Color !& wetness I From i To Well use: ( ) Public s4pply, (X) Domestic, Other StICI(Up 0 2 Depth of holt: 19k ft, Ceasing stickup: 2 ft Casing type: Steel Thickness: .250 1 inches i Casing diameter: 5 inches Casutgdepth:i 187 8 j silt & gravel 2 25 Lincr type: PVC j Diameter:_inches 'Depth:_2V-J95 ' - Static water (front top of casing) 119 ft on ,-3-r-Z/? coarse gravel w/ `It 25 53 Pumping level & yield: — feet after hours at _ gpm Recovery rate: R S gpm, Method of tcsiit g: airlift sated- - ----.------ 53 -_56 Development method: airlift ---- Duration:''1 !hour - '' Well intake opening ry(ie: ( ) Open end, (X ) Open hole, Other moist clay wJ gravel 56 60 Screened: Start: fl, Stopped _ it silt &gravel 60 142 Screen type: Slot/mesh size - I Perforated Start. i ft, Stopped. Start: ft Stopped! f1 p. ' clay layer 142 150 Note: ... ......... ............. j .........:............................................ moist silt &gravel 150 162 Groot type: - bentonite Volume - _ Depth; from _ground Surface , to : 20 It dry silt & gravel 162 165 Pump intake depth: Pump size: _ lap, Brand name: - wet clay layer 165 172 Was well disinfected upon completion? (X) Yes, ( ) No - Method of disinfection:.f.r71C1UDll'IYpoR(')).CCItQ.(Citl!]fJi71)...: silt ravel dry g 172 187 m Drillercotnents/disclaimers,:..... .............................. ............ :............ ..0.251Dg.St9P..Red..dii.�..$7..�..d.4le.t9..boulder,,drilled open,,,, r..entering.bTwe�n.92' tQ..1�.9' for boulder 187 189 a.total.ot..S.gpm battann.at.hole..19.5.'liD.r..installexl, wet clay layer, w/ gravel 189 192 Well driller name:...... Johany,.Kay...................... 1._ ......................... Company name :.... Hefty, DrillingInc..... Mailing address 3540.? kKy§.Dr, coarse gravel w/ H2O 192 199 City; Anchorage State AK Zip 9951 G clay layer w/ gravel 199 220 Phone number: ( 907 ) 345 - 059T% :345-4700 Drillers signature: Alaska state law requires that a copy of this well log be sent n) the Department orNatural Resources within 45 days: fixes are acceptable. (AK statutes 38.05.020, 38,05.035.41.(18.(12(L 46.15.020 and AK regulations l l AAC 91140)• DNR/ Division of Mining, Land and Water, 5.50 W 7th Avenue, Suite Anchorage, AK 99501- 3562 Phone (907)269-8639 and fax (907)269-8947 Within the City of Anchorage, it is required that a copy of the well log be sent to the appropriate city office within 60 days and that another copy of the well log be sent to the well/property owner within 30 days. Permit Number: OSP131078 Date of Issue: _EeU,j /2oj 3 Parcel Identification Number: Is well located at approved permit location' ( X) Yes or ( ) No Development Services Department Building Safety Division # On -Site Water ,& Wastewater Program 9�o 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 s .A . = T.Y, Mayor WWW.Muni.org/onsit (907)343-7904 Pump Installation Log Well Drilling Permit Number: SWAP/, j /rj / y Date of Issue: �5�3 Parcel Identification Number: U/Xl Legal Description Property Owner Name & Address: zz Sax Pump Installation Pump Intake Depth Below Top of Well Casing: / Meet Pump Manufacturer's Name: Pump Model: 7 ji > yiz GG Pump Size �yhp Pitless Adapter Burial Depth: (feet Pitless Adapter Manufacturer's Name: 'e'"69 /�? cic✓eS Pitless Adapter Installer: }Q� f�� ,-6, Well Disinfected Upon Completion 'kETYes ❑ No Method of Disinfection Comments: Z<.} �5-/�crs �ll� c�coJ� .�5✓ i !�� -74 oe /offru;C� Pump Installer Name: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Community Development Department On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 Well Decommissioning Log Legal Address: Subdivision /K/ 1115- Block Lot T R Section Lot On-site Water & Wastewater Program certified contractor performing the well decommissioning: Name;---� J��n Signature: Company:O��/ill iii (/J C•d�i_S Well decommissioning date ! �7 ZY Method of decommissioning: AMC 15.55.0601-1 a. ❑ b. ❑ Location: Use the space below to provide a drawing of the property showing the following items; • North arrow • Decommissioned well, • Other water wells on the property, Two separate swing -fie distances for each well shown on the drawing, Note: The swing -tie distances shall be measured from either permanentructures or the property corners. (✓ (J�i G, %fes �1 � Gr,9�it3 � G�corr,,�-an 7 unuommumty ueveiopmenttuevelopment ServiceslBuilding SafetykOn Site Water and Wastewatefformsk0lent Forms\Well Decommisioning form.doc Permit Number: Tax Code Number: On -Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 OSP131018 01512229000 Work Type: Well Upgrade Permit Effective Dates: February 25, 2013 to February 25, 2014 Design Engineer: ANDERSON ENGINEERING Subdivision: GOLDEN HILLS Site Legal Address: GOLDEN HILLS BILK 1 LT 3 G:2539 Owner/Address: TINDALL WESLIE W & MARLENE G PO BOX 112142 ANCHORAGE AK 995112142 Site Mailing Address: 10101 GROVER ST, Anchorage Lot Size in Sq Ft: 66129 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-122-29 Property owner(s) Weslie and Marlene Tindall Day phone 346-1826 Mailing address P.O. Box 112142 Anchorage, AK 99511 Site address 10101 Grover Street Anchorage, AK Legal description (Sub'd., Block & Lot) Golden Hills, Block 1, Lot 3 Legal description (Township, Range & Section) Lot Size 66,129 Sq. Ft. Number of Bedrooms Three APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) X❑ (w/wo ADU) Septic Tank ❑ Upgradex❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. of property owner or Permit/Rush Fees: aO0 Date of Payment: 15 Receipt Number: D 66(og Q5i Permit No. MPI 31018' Permit App_-'.:. Waiver Fees: Date of Payment: Receipt Number: Waiver No. GROVER STREET •xeeevox Beer N00°08'07"E (R) 155.55' 10' Electrical Easement F ------------------------------- I I I I fj)cn m G (D X I "a ui 'DE3 D c I � o Z " O M C 3 3)m 0 I 7o(mD " n 0 n M I z C r of (D O� _ _1 U r C I m / M n rt p (D I / N Cu 3 I D n (a < I 0 Z o \ X I D' *M L---------------- (D I --� x. v -----I----- = rt 20I Electrical Easement-- —1 /--------- 2 03.36' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMEN TAI,. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 95501 Telephone 264-4720 \-- ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR M-L.L. INSPECTION REPORT NAME,..�-�a. PHO(N�E NEW =7/)1" 3❑ UPGRADE --1��-' --�y flo _ _ 71 MAILING ADD/f}(-FSS �/' nJ 0 /` /6 LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ® Well Absorption area Dwelling DISTANCE TO: - PERMIT NO. F- Manufacturer Material No, of compartments in oY�_ Llq. ca �acity_in gallons Inside length Width Z,s IF HOMEMADE: Dwelling Liquid depth PERMIT NO. �(7Z i v h DISTANCE TO: Well Manufacturer Material Liquid capacity in gallons O w Well Foundation Nearest lot line DISTANCE TO: PERMIT NO. J is 7 F- Z No. of lines Length of each((Iijm Total length of (lined Trench width / �� Inches_ Distance between lines CL rc I- - -._ ---v-� air Top of tile to finish -g� 19 Material beneath the Total effective abs tion area q-- inches Length Width Type of crib Crib depth Total effective absorption area q I- a� Crib diameter Lu DISTANCE TO: Well Building foundation Nearest lot line a w � Class DISTANCE TO: Depth Building foundation Driller Sewer line Distance to lot line T PERPAIT NO. Septic tank Absorption area(sl - OTHER — PIPE MATERIALS SOIL TEST RATING INSTALLER ��ff ______ 54 /t REMARKS - -- — I -- �— - ) r// /u�- rood I� I re - o 27 57 e !.-X IX, - -- -- APPROVED DATE LEGAL THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS' ���y MI -1 ==m �22. ����(it ����= �� ����FE. L— Y'll. ...� � THE LENGTH DIMENSION IS THE LENGTH (IN FEET::- OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETNEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET). FR, E.'- L-11 1: E -Z* R,: -,I �IEEE ��T C- W fol 04 10. �I 2-f E--' --l. Ca vE7.-.m C..-fil fol Q. U. C"�:p��� PERMIT HPPLICHNT HHS THE RESPUNSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTALLATION INSPECTIONS OF HNY WELLS TO THIS PROPERTY HND THE �UMBER OF RESIDENCES THAT THE WELL WILL 'E;ERVE. ~~� R R—:N ��::::n 1 11 �4 SE--, F::' IlE-- -y- I RTR P,l in; f0l FR F �11-3 Y E.E. ED- BHCKFILLING OF HNY SYSTEM WITHOUT FINAL APROVHL BY THIS DEPHRTMEPIT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN R WELL HND HNY ON~SITE SEWAGE IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPUN THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVATE WELL TO H PRIYHTE SEWER LINE IS 25 FEET AND TO H COMMUNITY �ENER LINE IS 75 FEET. OTHER REQUIREMENTS MHY HPPLY. SPECIFICHTIONS AND CONSTRUCTION DIHGRHMS HRE HVHILHGLE TO INSURE PROPER INSTHLLHTION 11""KENTA"I 3: 0- ��F�:" 1 ��E" J- --r �75-'fl�� I CERTIFY THAT 1: I HM FFMILIAR WITH THE REQUIREMENTS FOR SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2: I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH -0-IE COD�S ]: I UNDERSTAND THHT THE ON—SITE SEWER SYSTEM MH� REQUIRE ENLHRGEMENT IF THE RESIDE HN ] BEDROOMS. HPPLICHNT WESLIE W TINDHLL DEPRRTMENT L HEHLTH HND ENVIRONMENT8L . JTECTION 325 'L' STREET. HNCHORHGE/ HK. 99501 264~4720 M Ir -1 1~� PERMIT NO. ( 810]26 ) HPPLICHNT WESLIE W TINDHLL BOX 10~2142 ]45--4195 LOCHTION GROVER ST LEGHL LOT ] BLK J. GOLDEN HILLS S/D LOT SIZE 68000 SQUHRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS = ] SOIL RATING 0 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS' ���y MI -1 ==m �22. ����(it ����= �� ����FE. L— Y'll. ...� � THE LENGTH DIMENSION IS THE LENGTH (IN FEET::- OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETNEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCHVHTION (IN FEET). FR, E.'- L-11 1: E -Z* R,: -,I �IEEE ��T C- W fol 04 10. �I 2-f E--' --l. Ca vE7.-.m C..-fil fol Q. U. C"�:p��� PERMIT HPPLICHNT HHS THE RESPUNSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTALLATION INSPECTIONS OF HNY WELLS TO THIS PROPERTY HND THE �UMBER OF RESIDENCES THAT THE WELL WILL 'E;ERVE. ~~� R R—:N ��::::n 1 11 �4 SE--, F::' IlE-- -y- I RTR P,l in; f0l FR F �11-3 Y E.E. ED- BHCKFILLING OF HNY SYSTEM WITHOUT FINAL APROVHL BY THIS DEPHRTMEPIT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN R WELL HND HNY ON~SITE SEWAGE IS 100 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPUN THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVATE WELL TO H PRIYHTE SEWER LINE IS 25 FEET AND TO H COMMUNITY �ENER LINE IS 75 FEET. OTHER REQUIREMENTS MHY HPPLY. SPECIFICHTIONS AND CONSTRUCTION DIHGRHMS HRE HVHILHGLE TO INSURE PROPER INSTHLLHTION 11""KENTA"I 3: 0- ��F�:" 1 ��E" J- --r �75-'fl�� I CERTIFY THAT 1: I HM FFMILIAR WITH THE REQUIREMENTS FOR SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2: I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH -0-IE COD�S ]: I UNDERSTAND THHT THE ON—SITE SEWER SYSTEM MH� REQUIRE ENLHRGEMENT IF THE RESIDE HN ] BEDROOMS. HPPLICHNT WESLIE W TINDHLL SOILS LOG MUNICIPALITY OF ANCHORAGE OF HEALTH & MUNICIPALITY OF ANCHORAGE �/,ENI,M P:-,TECTION PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST /'rte graClq 625 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST RECEIVED PERFORMED FOR:�- - 1) S `"� � �� ate y �� �r-o�7'U���{{I7 �E`S: DATE PERFORMED: LEGAL DESCRIPTION: le `� /J�l� (..:� S /tY/I4i (J'7 l(S SFI IEi`I DEPTH l`jSSLLO"�PEE f �jSITE PLAN (FEET) E I I I �C� y� z 3 t 11-12 //­ (n) 51 5 6 J0� 7 8 10 11 12 13 5i//�Ct 25 to a� yra,�—t• 14 - 4 15 16 P� SI.yGf/y17 . 18 19 20 WAS GROUND WATER S ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop ® ` _ a •�l y . PERCOLATION RATE - (minutes/inch) �jq q / TEST RUN BETWEEN FT AND FT COMMENTS ?G-�C��__1,7`20 PERFORMED BY: �(F�J.3 / L�-.-i't -4 CERTIFIED BY: 7— 72-008 (6/79) DATE: �Z'--xw�/ 1. 71m/�_ 12A)U)�:I) gek MA,)� c )� /'i �7s cGy ��yr/ 5f9.�-� Eel Municipality of Anchorai On -Site Water & Wastewater Program (907)343-7904 l7 � A\o � APR � � 2016 3 CERTIFICATE OF ON-SITE SYSTEMS APPRO Parcel I,D. 015-122-29 Expiration Date: 2 ! 1 1. GENERAL INFORMATION Complete legal description GOLDEN HILLS; BLOCK 1, LOT 3 Location (site address) 10101 GROVER CIRCLE *ANCHORAGE, AK Current Property owner(s) MARLENE TINDALL Day phone 240-1453 Mailing address 10101 GROVER CIRCLE *ANCHORAGE, AK Real Estate Agent KATHY FERNANDEZ Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 441-9000 Waiver/Variance request for: N/A Distance:= Received by: /11� COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ P-7� ' Date of Payment ?bS` Receipt Number D$b�'1 G\ COSA# 65U Date: Y/� 7/ Ik Waiver Fee $ — Date of Paymeni Receipt Number Waiver # TYPE OF WASTEWATER DISPOSAL: ® Individual On-site IN ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ Waiver/Variance request for: N/A Distance:= Received by: /11� COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ P-7� ' Date of Payment ?bS` Receipt Number D$b�'1 G\ COSA# 65U Date: Y/� 7/ Ik Waiver Fee $ — Date of Paymeni Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l 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. 2riClim 3701 E. TUDOR ROAD, SUITE 101 "ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting This evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance wtth the guidelines and regulations established by the Municipality ofAnchi age and mousirypadices. The reported results describe The condition of the syslemds on the datens of the evaluation. Sepaalion distances were measured to readdyidenlifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all vrells and septic systems depend we variety of variables including, but not limited to, soil conditions, groundwalerlevels (That' may ductuale during the year), quality of construction (materials and workmanship), and the water usage ofthe family utilizing the sysfe Ws. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guaamee fulum performance of the system/s, therefore, GEG makes no warranty (express or implied) regarding the future performance of the well 7septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event edheroflhe current systems fail. The content of This report is forthe sofe benefit of the persoNpady, who relained GEG. Reliance upon The information provided in this repod by any other person orlomfy, indudinrg but not limited to subsequent propedypurchasers, is not authorized. In short, GEG disavows any legal duly to anyone olherthan The peaoNpady who paid for his report. 6. DSD SIGNATURE 0 System #1 Approved for -3 bedrooms. Phone 337-6179 Date 3/zeift7 irrey A. GaTtWess CE -7953 � i 2 `1•I/ � •' ��Coi /'ROFESS��Ne.•� System #2 Approved for bedrooms. \�_\TYOFq Disapproved. �G Sip Conditional approval for bedrooms, with the following stipulation ON-SITE 9� WATER AND m PROGRAM Original Certificate Date: q--27--IL The Municipality or Anchorage Develop,errit 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 10112112) 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: GOLDEN HILLS; BLOCK 1, LOT 3 Parcel ID: 01 I A. WELL DATA 1978 WELL IS TO BE DECOMMISSIONED IN THE SPRING OF 201 Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (YIN) YES Date completed 3/7/2013 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 195 ft. Date of test Static water level Well production Cased to 187 ft. FROM WELL LOG 3/7/2013 119 ft. 3.5 9.p -m. WATER SAMPLE RESULTS: Casing height (above ground) 18+ in. AT INSPECTION 3/8/2016 119 ft, 1.08 g.p.m. Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GFG. Ltd. Arsenic: NO ug./L. Date of sample: x//2016 B. SEPTIC/HOLDING TANK DATA STEEL SEPTIC TANK (35 YEARS OLD) IS APPROACHING THE END OF ITS USEFUL LIFE. Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date installed 8/19/1981 Cleanouts (YIN) YES High water alarm (Y/N) N/A Date of pumping 3/9/2016 Pumper ISAACS PUMPING SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 8/19/1961 Soil rating (g.p.d./ft2or !bdr 220 System type DEEP TRENCH Length 55 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total depth *9.5+ ft. ; Eff. absorption area 660 W Monitoring tube **YES , Depression over field NO Date of adequagy test 3/8/2016 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 15 in. Water added 642 gal. New depth 21 in. Elapsed Time: 120 min. Final fluid depth 15 in. Absorption rate >= 450+ g.p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — **MT ONLY EXTENDS APPROXIMATELY 58 INCHES BELOW INVERT D. LIFT STATION Date installed Size in gallons Manholelikccess (Y/N "Pump on" level at in. "Pump off' level High water 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'+ Absorption field on lot 100'+ Public sewer main Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 75'+ 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 :9 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 **0' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER 1981 INSPECTION REPORT **CODE COMPLIANT IN 1981 G. ENGINEER'S CERTIFICATION t 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. Engineer's Printed Name JEFFREY A. GARNESS Date 312-9 1 it, (Rev. 11/05) ry \ 1 x10' Utility Easement O eptic vent 7. to M L6 to r I 0 0 J 00 C) O 0 r+ Its4 z z w wl LU O r Septic Lot 6 Hillside Par{ 3 Story Frame House n� v>1 b'/' Lot 2 S89056'40"E 281.29 OH link fence Lot 3 10' UTILITY EASEMENT S89056'40"E 331.9.0 - Lot 7 PUD Subd. It .4 A, OF q�gS�, 49th / ��n Fred Walatka: p .: p .' 3255 — S i. AW SCALE: 1"= 50' ... �EESSIeNAL +� EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FB 16-1, pg 23 BE CD J M ( 0 11 N W �¢LU O O J —Q 'O Z r T 0 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 3. BLOCK 1. GOLDEN HILLS SUBDIVISION Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property tying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 14th day of MARCH ,2016. FRED WALATKA & ASSOCIATES Engineers and Surveyors (907-248-1666) 5. LEGAL DESCRIPTION s a7- DATE RECEIVED INSPECTION APPOINTMENTS N sA �,Q . A(_-, P. TIME TIME TIME ED One ❑ Four ❑ Other _ l_t t_ -A ti n 4 DATE DATE DATE 'INDIVIDUAL* t K \(A-0'-'\ CX"ys1v\ INSPECTOR INSPECTOR - INSPECTOR'J\ mUMTCrA=oP ANCFI(JRTGE MUNICIPALITY OF ANCHORAGE DEM. ,: DEPARTMENT OF HEALTH &ENVIRONMENTALPROTECTICFMVII`,G'.�i1-.�'�;.-,!-.-,..-,�-JCTION 825 L Street • Anchorage, Alaska 99501 if !V1 0* ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 ry ECL C 0 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 00) days for processing. 1. PROPERTY OWNER PHONE 1,Jj9 -?Y7 .� s� 4,10Lt�h e' MAILING ADDRESS - - )21 0 , 13 O 2-/1/ 2- IP":r A f PROPERTY RESIDENT (If different from above) 13 loc ! r PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION-� PHONE MAI Ll NG/ADFSS I _ 4. REALTOR/AGENT , . PHONE MAILING ADDRESS'1�...... 5. LEGAL DESCRIPTION s a7- STREET C�A�TIO� D' 12-0 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS 12�SINGLE FAMILY ED One ❑ Four ❑ Other _ ❑ Two ❑ Five ❑ MULTIPLE FAMILY _Three ❑ 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. SEWAGE DISPOSAL SYSTEM L INDIVIDUAL/ON-SITE** _YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 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 ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tart 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 PROVEDFOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE _T BY�(