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KASILOF HILLS BLK 1 LT 3
K Silof Hills Block 1 Lot 3 #015-161-07 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 05P10155 PID Number: DIS- IW -04 Name: Wastewater System: ❑ New rade Address: 110 Sf prive. }� ABSORPTION FIELD 80 ro 4 ot= ISTl nj Phone: Numberof Bedrooms: 7� ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other: LEGAL DESCRIPTION Sod Rating: Total Depth from original grade: GPD/FIT F[. Block: Lot t� Subdivision: I t 3 K-4 Hlllf, Depth to pipe bottom from original grade: Gravel depth beneath pipe: FL Ft. Township: Range: Section: Fill added above original grade: Gravel Length: Ft. Ft. Well: �KiStiGravel ❑New El Upgrade width: Number of lines: Distance between lines: H, Ft.Classification (Priya A, B. C): Total Depth: I Cased M: Total absorption area: Pipe Material: FL H. Fe Driller: Data Dulled: Static Waler Level: Installer: , A+ tlom(= JeNlcen Data Installed: Z(. 111 Ft. Yield: Pump Setat. Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES XSeptic ❑ Holding ❑ S.T.E.P. ❑ Other: To From Septic Tank Absorption Field Lift Station Holding Tank ublic/Pdvate Sewer Line Manufacturer : _ Aflc6c IAnk Capacity: /n��^ )Wb e G.J. Well I �� t Material: JC22{ Number of Compartments: 2 surface water I�UI+ LIFT STATION Lot Line C r+ Size: anufacturer: J Gal. Foundation 1 �1 T 'Pump on level at: 'Pump off' level at High water alarm at rn in In Curtain Drain t # Pump Make & Model Electrical Inspections performed by: Remarks: BENCH MARK i L`.I5�1ra 1 k - VJOY) igen A Location and Description SU 16AOM Sid'n Sul CorneA GLtAfx e CAssumed Elevation: 1` 1 1'h ✓1�� �D� FL �P�1 O Eni�tul`\\ Inspections performed by: A( 2��4n Dates: 1a` Zb I -- 2nd Development Services Department Approval q(.�F•.A4,q 49TH Conditional Approval Date:i " ..:GVI�..�.... E. URKLAND:� I% 115 0 i �11N Reviewed and approved by: Date: - " /� \\ SS1� P— (Rev.04/06) \ \ \ \ LOT 4A — — I S smw W A D I Q F SECO.D 21's 'ss' I pst� K1 DrL ase • I K p G V r a f 38 3s,• u4D• I B I I Lar 7A Septic! Area LOT 8A NOTE., THIS IS NOT A SURVEYED PUT. WELL kS£PT7C LOCATIONS TAKEN fROM ON-SITE WATER AND WAN WATER DEPARTMENT DOCUM£NTAI M ALL LOCATIONS SHOWN ARE APPROXIMATE. DW&E CLEAN"'""' I LOT 2 25 0 25 50 75 100 125 150 SCALE, I' = 50 FT / 4 FEET COVER CONNECT TO, EXIST DRAIN7ELD 1000 CALLON SEPTIC TANK VNECT TO 7NG LINE FOUNDATII N CLEANXIT ASSUMED £M10SMING0' S£ CORNER GARAGE"1tA��n ! Vx- 203 W WAND ENGINEERING KASILOF HILLS BLIC 1 LOT 3 SEPTIC SYSTEM ASBUILT ANCN AK 199501 VENUE RUSSELL MARTIN DATE: SEPT. 7, 2011 (907) 279-3916 11060 STROGANOF, ANCHORAGE, AK 99516 SHEET. 1/3 GRID: 2641 PERMIT #OSP111153 PID # 015-161-07 KHBIL3.DWG On -Site Wastewater Disposal 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 Permit Number: OSP111153 Tax Code Number: 01516107000 Work Type: Septic Upgrade Permit Effective Dates: July 18, 2011 to July 17, 2012 Design Engineer: SPURKLAND ENGINEERING Subdivision: KASILOF HILLS Site Legal Address: KASILOF HILLS BLK 1 LT 3 G:2641 Owner/Address: MARTIN RUSSELL T & MARGARET A 11080 STROGANOF ANCHORAGE AK 995161254 Site Mailing Address: 11080 STROGANOF DR, Anchorage Lot Size in Sq Ft: Total Bedrooms: This permit is for the construction of: %/Z 61V Z/,-1 28414 3 N Disposal Field Y Septic Tank N Holding Tank N Privy N 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 By: - 8 _ .. - MWA Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Allayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. OIS-161- 0-+ Propertyowner(s) Rtsseen Kma� -, Dayphone 3410-4300 Mailing address Siteaddress HO'80 Stroq,",of 1)riJL Legal description (Sub'd., Block & Lot) kc,, i Ij qi N 131K) 03 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Initial ❑ Absorption Field ❑ Septic Tank Upgrade Tank ❑ Renewal ElHolding Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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. property owner or Permit/Rush Fees: oZUO "`� �Of Waiver Fees: Date of Payment: "�-11 --1''1tt Receipt Number: OLIOID `1 Permit No. OSp Illi 5 3 Date of Payment: Receipt Number: Waiver No. GABuildinglOn SiteTormsUient FormsTevnit App_010411.doc (Rev. 1111) 11 13 SpUft� and EnUMBRmu Environmental Consulting and Design July 8, 2011 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION Kasilof Hills Block 1 Lot 3 Ladies and Gentlemen: We are submitting an application to replace the septic tank for this lot. The existing septic tank has collapsed. The submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. There are no wells within one hundred feet of the proposed replacement site. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. Sincerely, Lars S urkland, P.E. 203 West 15th Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net \ \ LOT 4A S \ I LpF i LOT 7A Septic Area I I I LOT 84 I I NOTE. THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. DOUBLE CLEANZ 0 a 0 LOT 3 I LOT 2 I o 1 25 0 25 50 75 100 125 150 SCALE- I' = 50 FT 4 FEET COVER FOUNDATION CLEANOUT OF CONNECT T179 h EXISTING LINE %"' """"" "" "" "" "" •°"' ......5�r CONNECT TO 1000 GALLON SEPTIC TANK / .....S SPURKLAND i2j o EXIST DRAINFIELD C N CE -11500 •�� FII �'•••....... •• ''�,�'��• BENCH MARK ASSUMED ELEVATIONX100' ����%JAYA% w; SPURKLANO ENGINEERING K4SILOF HILLS BU 1 LOT 3 SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE DATE. JULY 8, 2011 ANCH. AK. 99501 RUSSELL MARTIN (907) 279-3916 11080 STROGANOF, ANCHORAGE, AK 99516 SHEET.• 1/3 GRID: 2641 PERMIT #OSP111XXX PID # 015-161-07 KHBIL 3.DVG i i i ► _� � 0 I I I I I � I ;�\ � /" � LJ Ll � � I � � L1 LJ 0 � LJ Ll � � LJ � LI LJ 0 v � lltA11 LJ LL11 UU lWW! l:�l Environmental Consulting and Design Single Family On-site Wastewater Disposal System Construction and Material Specifications Subject Property: Kasilof Hills Block 1 Lot 3 Date: July 8, 2011 General: 1. The owner shall contract with a contractor to perform the work outlined in these specifications and plans in accordance with the attached MOA permit. There is not contractual arrangement between the contractor and the Engineer. The Engineer shall be the owner's representative and will inspect the work to document the contractors activities. Final acceptance of the contractors work rests with the owner and the MOA. 2. The scope of the work includes the installation of a new 1000 gallon septic tank. The location of the drain field is shown on the attached site plan drawings. All components of the proposed septic system must be constructed a minimum of 100 feet from any surface water or water wells in the area. A minimum of 4 feet of earthen cover is required over the septic tank. If less than 4 feet of cover is available, 2 -inch thick, 40 psi, direct bury board foam shall be installed directly over the septic tank and all installed piping. 3. Construction shall be in accordance with the approved site plan and design drawings and any special provisions noted on the Municipal well and/or septic permit. All materials, components, workmanship and construction practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA, Development Services Department, On-site Water and Wastewater Program (DSD) policies. 4. The contractor is responsible for obtaining all underground utility locates, layout of the proposed system, and verifying and maintaining all required separation distances to lot lines, surface water, wells, steep slopes, etc. S. The property owner shall be responsible for final grading any depressions formed from settlement of backfill material. The property owner is also responsible for vegetation of all areas disturbed by septic system installation activities. 6. Contractors installing wastewater disposal systems must be certified to do so by the MOA DSD, On-site Water Wastewater Program. Property owners installing their own systems must receive advanced approval from MOA DSD prior to system installation activities. 7. The contractor shall ensure that ALL materials being used are in compliance with the most current guidelines established by the Municipality of Anchorage. Refer to "Standards and Specifications for Component Parts and Materials Used in the Construction of On-site Wastewater Disposal Systems", Dated December 2000, as provided by MOA DSD, On-site Water and Wastewater Program. 203 West 15th Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net SpuMand g g Environmental Consulting and Design Septic Tank Installation: 1. A new septic tank, of the size specified in the design drawings, shall be procured from a qualified manufacture/supplier. Construction shall include two 4" diameter cleanouts for pumping access. 2. The burial rating of the tank shall be adequate for the actual burial depth encountered. 3. The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank. 4. All standpipes on the tank shall extend a minimum of 12inches above the final grade. 5. Tanks installed with less than 4 feet of cover shall be insulated. 6. The sewer service line from the house to the tank shall have a minimum slope of 2% unless prior approval is obtained from the engineer. 7. The inlet and outlet lines from the tank shall be bedded in drain rock or the soil shall be sufficiently compacted to prevent future settlement of the soil. 8. Septic tank inlets, outlets and cleanouts shall be fitted with water tight couplings. 9. Post tank cleanouts shall be installed per MOA requirements. Does not apply to pressurized lines. 10. In areas with high ground water, the septic tank shall be sufficiently anchored to resist buoyancy forces when there is not adequate soil cover to resist uplift force. The contractor shall refer to the engineer for direction regarding this matter. 11. The tank backfill shall be graded sufficiently to ensure positive drainage away from the tank. 12. All holding tank and lift stations shall have an audible and visible alarm inside the residence being served. 13. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electrical Code. A municipal electrical permit and inspections must be obtained where required by the MOA. 14. The contractor shall verify that the septic tank/lift station is a minimum of 100 feet from any residential water well, 150' from any class 'C' well and 200 feet from any community water wells. Additional separation distances must also be maintained. 15. The contractor shall remove or abandon the existing tank in compliance with the Uniform Plumbing Code. Inspections: 1. A minimum of one inspection is required by the Municipality of Anchorage. These inspections must be conducted under the supervision of a Professional Engineer licensed to practice in the State of Alaska. 2. The septic tank may be set in place, but may not be backfilled. 3. The contractor shall provide a legible copy of all field notes relating to system layout and construction to the engineer for the use in preparing the record drawings. 4. The contractor shall coordinate all inspections with the Engineer. A minimum of 24 hours notice is required prior to the start of construction. If necessary, a preconstruction meeting will be held on-site. 203 West 15th Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE •��1; /) NEW ❑ UPGRADE MAILINGADD S rs r A(l LEGAL DESCRIPTION (� 1 ` Q LOCATIONNO. lf> _ OF BEDROOMS _-) �. x DISTANCE TO: W ��fJt_1 ri Absorption area Owe lin 1n_-n<"/n PERMIT _ - y h Manufacturer /i , / Materials-, J No. of compart mapatb ( Y , 1 Liq. cap city'„ gllons IF HOMEMADE: Inside length_ Width - Liquid depth O z DISTANCE TO: Well Dwelling PERMIT NO. 2 Z F Manufacturer Material Liquid capacity in gallons DISTANCE TO: rill Poundatiop 1F' Y� Nearest lot lin ' �-? PERMIT O t I� u- Z No. of lines ength of each line Total length of I'q e��s*,, Trench w d V6 Distance between lines Nuj C}(_> inches b Top of tile to finish grade Material beneath the �'� inches Total effective absorp iovrka ,'77i cJ t w Length Width Depth PERMIT NO. 0 oa Type of crib Crib diameter Crib depth Total effective absorption area wa vi DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. W W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER 4t PIPE MATERIALS SOILTES RATINGI I INSTALLE ( % REMARKS v /� ► tom, !/ c c�>rer L �{ 1?t in r} APPROVED DATE LEGAL LL L vU I knev. 0/ /0) Department 825 L # a� Permit # ',7_>C -)y Al WELL Applicant: Location: Z MUNICIPALITY OF ANCHORAGE l f Health and Environmenta Protection C)) �{ Street, Anchorage, AK. X9501 �r 264-4720 HANDWRITTEN PERMIT # AND/-TgON-SITE SEWER PERMIT�� �j y i"y• Mailing Address: 6,'I; _ v A1�a Phone Number: 43 C/- GG - %/ Legal Description: G I Type of Soil Absorption System Is: Trench: � Drainfield: Seepage Bed: Maximum Number of Bedrooms: b Z% Lot Size: 2 � d Holding Tank: _ Soil Rating(sq.ft/br) / '?� a The Required Size of the Soil Absorption System Is: DEPTH 2 e-1 LENGTH GRAVEL DEPTH /- WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ D 0GALLONS # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # TWO(2) INSPECTIONS ARE REQUIRED # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. Signedc-�� %� Issued by: QL Applicant Date: SWP/024(1/81) >Q SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION F PERCOLATION TEST j 625 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: �-e I e DATE PERFORMED:_ 1`` Y l l_�) LEGAL DESCRIPTION: E - ) 1 1 2 3 t:n CIM `�YDLsJYI �r'av�I�L1 slll 4 5- 6 ,6 7 8 10- 11- 12 0 11 12 13 4f 14 15 A 16 17 18 19 20LTw COMMENTS PERFORMED BY: 72-008 (6/79) WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE ITE PLAN N0 S O P - E Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE_ ____(minutes/inch) 11 _ _ c.TEST RUN BETWEEN LIY @FT AND w���� FJ"f ec_I Iii 1-� � Vl n' o )lu I-- o V K 1. t CERTIFIED BY: DATE: L- 2) , M SOILS LOG MUNICIPALITY OF ANCHORAGE • +`,' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION i, 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR: ��2J Ci �� DATE PERRFORMED:-"- LEGAL DESCRIPTION: ') Zf /rvl I&Airyl /✓ �/I l�/Lo/<-. SLOPE SITE PLAN 1 ndj ss I+ -Cew qrc. ,v QAs FFFH �1 I 4-H 42 3 4 5 6 7 8 9 10,^• 11- 12 13I 14 r AV 15 17 18 19- 20 COMMENTS AM �3I rood -s L LJIJIJIC.c WAS GROUND WATER S ENCOUNTERED? i L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: & nonr CERTIFIED BY: 72-006 (6/79) FT AND (minutes/inch) — FT DATE: WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8l Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either to, Ib or Ic.) A.D.L. No. IBorough Subdivision Lol Block Ib. l/4 at rs. Section No. Township N E] Range EE) Meridian • .. _ _Of— of—of S❑ WO Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Address: Street Address and Area of Well Location 2. WELL LOG Foot Below Surface Material Type Top Bottom 4, WELL DEPTH; (final) ft. 5. DATE OF COMPLETION —A- �— m-- 6. D Cable fool 0 Rotary Ej Driven E] Dug LJ Auger Jetted ❑ Bored © Other: _ - 7. USE: Domestic D Public SupplyD Industry Irrigation D Recharge F1 Commerical Test Well D Other. _ 1 8. CASING: Threaded U Welded diam. into ff. Depth Weight Ibs./ft. diam. in. to ff. Depth Stickup _ ft. 9. FINISH OF WELL.: Typo: Diameter: Slot/Mesh Size: Length: Set between _ ft. and Backfilling _ Gravel pack _ _ 10, STATIC WATER LEVEL: 9_ft. _ ❑ Above or ❑ Below land surface Date Equipment used: II . PUMPING LEVEL below land surface and YIELD • }t. after _ hra. pumping - g.p. M. _ft. after --hrs. pumping g, p. m. 12.GROUTING Well Grouted: Dyes Q No Malarial: D Neat Cement U Other: 13. PUMP: (if available) HP Length of Drop Pipe It. capacity gp. in Subm. Jet Centrifical Ej Other 14.REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: --- 15. Water Temperature --a F C This well was drilled under my jurisdlclion and this report is true to the best of my knowledge and belief; "i'll"ALTER N. WHITE Registered Business Name3720 Wes41TlIf1SfC'.'Wy, Contract License Number A Address: - lTCf10P3 Sd, AK 995o8 --- Signed: Data: Authorized Representative Form 02-WWR (11/81) Copy Distribution: WHITE -State OGG$, PINK - Driller, CANARY- Customer MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 3 / 2g (®( 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 1-of3, B(ock L, kurrtoF (tal(-r Location (address or directions) v 04 or( ( of -le, C(,e e,-- O ' Ma (/e V (b) Applicant Name Pceulcc He" dOO Telephone: Home .Sz2 -/030 Business ,3 `y5 --777y'( Applicant Address % lie Max R!T. (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other 0 (explain); ft'ecv /o r RE (e) Lending Institution Address Real Estate Company and Agent f Address Telephone —522 e 1030 Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-FamilyER Multi -Family ❑ Other Number of Bedrooms 3 Telephone _— Re Fla Noo�el (V 3YS-13ST when n�aryy - A 3. WATER SUPPLY Individual Well ® Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ® Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Ponn 1 ni 0 72-025 t11, 00 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 - Ela fIV_eC64teu ( Ser✓�c�l Telephone `>S' -l3ss- Address 1 Y530 15 S f Date Aoc6Cr V -ey Al -r THEODORE F. PAOORE ; lA 4' ,•• CI. - 3589 •Enpir76er's Seal 6. DHEP APPROVAL �) i 4 � l Approved for 4 r t G bedrooms by w �L t Date `� »I Approved _ Disapproved Conditional Terms of Conditional Approval dhe� CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Pon. 9 of 9 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGC DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION AR 28101 Legal Description: Loi 3 -: ?KEWJ D FCastlof #I/la -S/Z) A. WELL DATA Well Classification f rt✓eth If A, B, C, D.E.C. Approved (Y/N) N, A. 91, us n►ew�r• of Well Log Present (Y/N) Y Date Completed 9 / 2 V X8-3 Yield ©. e4' dnllars (ay Total Depth 2�lS' Cased to 7' en Depth of Grouting Ah. Static Water Level KSS roc Pump Set At _ 1999 Casing Height Above Ground 189 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot 115 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot f ?S` —; On Adjoining Lots — To Nearest Public Sewer Line NIA, To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot /404 Water Sample Collected by 7`/�Iz ; Date — l2.5'/eel Water Sample Test Results /If&en b acie74 C _ Comments((v re/d meal ctroo( > 0 Jle (47,.i;' jVm? oo 31 ze- led- Pc4mp Stf 190 1�! rria9cted lo`eJ &mif ectmrp suri%< B. SEPTIC/HOLDING TANK DATA Date Installed 916"" Size 100— 017No. of Compartments _ G Standpipes (Y/N) Air -tight Caps (Y/N) _ Y — Foundation Cleanout (Y/N) 14 Depression over Tank (Y/N) N _ Date Last Pumped 3 /Z569 Pumping/Maintenance Contract on File (Y/N)for Holding Tank High -Water Alarm (Y/N) N,4. Temporary Holding Tank Permit (Y/N) NO- — Separation Distances from Septic/Holding Tank: To Water -Supply Well — 116.` To Property Line I 30 ` To Water Main/Service Line _ N.A Course T loo' Comments Page 1 of 2 79_n9R111/Rd1 To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1120 4, /(jdrm Type of System Design _ Treneti Date Installed 9 /9 /&-3 Length of Field 20 Width of Field �f 8 Depth of Field Gravel Bed Thickness 10a, Square Feet of Absorption Area 360 Standpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test i4cQeauaAe ,Coi 3 bedroo.n.J Separation Distance from Absorption Field: To Water -Supply Well 1 zs" To Property Line 0 To Building Foundation 20� To Existing or Abandoned System on Lot N•A. On Adjoining Lots 7 301 To Water Main/Service Line N.A. To Cutbank (if present) ,f;t( banR dr'rer" «bore To Stream/Pond/Lake/or Major Drainage Course > too To Driveway, Parking Area, or Vehicle Storage Area 15 Comments tfoAd6e.q Abe eaf dacvuArear, coo( ooh ee,-Ao_rafrce pie Wo4eq 4 hewe been 'Ins)06ded torf5 ¢/bow irrr/e gorfor-a4et n'epeae so ria vneo*ev&me41� pF �fuiv peepp f6 in Crave( is 1lo.tlfb(e. $pj- m acce�►t( 1 0 ,?ff0n Sale ca/acif a• 3/2g/#r V V D. LIFT STATION NeA. Date Installed 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 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Er v . F ?x - Date 3/ 28186 Company PY AIy %cilntcs+/MOA No. A"'e'B Receipt No. �`��•�••��0®� Date of Payment-��`� ' Amount: $,{� rja,`\ p® Engineer's Seal 4 9 T V :. - �•••e •o•••ea••••e ••o o/yyi * 4 Page 2 of 2 �] : THEODORE F. MOORE ; ^,• CE - 35£39 .- w �� �°: 72-026 (11/84) Cqenc ••..e•.••° tea � NOR iHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99701 907A79-3115 6957 OLD SEWARD HIGHWAY, SUITE 101 ANCHORAGE, ALASKA 99518 907-349-8623 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT ❑ PUBLIC WATER SYSTEM I.D. # 51 PRIVATE WATER SYSTEM NAME 0/63e> {., _ Mailing t�"dress t'12t cLtk City State Zip Code SAMPLE DATE: .3 ��~ C"ia Phone Mo. Day Year Purchase Order No. SAMPLE TYPE: L5' Routine ❑ Special Purpose ❑ Check Sample (for original contaminated sample with lab reference no. Sample Time No. Location Collected 1 R._ i ,yrs t lG f Ir�f�fi 2 3 4 5 6 7 8 9 10 Signature of Representative ❑ Treated Water Untreated Water Collected by / Lebo story ReI. No. 1,7 : '-r/j/'9 i / 71-i FOR LABORATORY LABORATORY USE ONLY CASH CHARGF PREPAID 7 TRANSMIRAL I SPECIAL INSTRUCTIONS MAIL OB HOLO FOR PICKUP TNTC TO BE COMPLETED BY LABORATORY Received at: 9 Anch. ❑ Fbks. Date Received Time Received 1160 Next Sample Due COMMENTS: SATISFACTORY 0 UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB 1'00 NUMEROUS TNTC TO COUNT Direct Verification Final count LbU burs nasun• comments *No. of Tje;al Coliform Colonies per 100 mis. Date Time Property Owner Mailing Address Buyer -_---- Address Lending Institution Address Realty Co. & Agent Address Legal Description Street Location dAPPL'°'°rill'I' FILLS OUT UPPER FIA' ONLY Fe.jes Devej.opment. 6917 Old Seward. highway 7q7 Code- _ Til, Code Lot 3 Flock 1 Kasi.lof Hills Subdivision Type of Residence XXnge Multiple Family No. of Bedrooms three Other Water Supply XX Individual ATTACFI WELL LOG. A well log Is required for all -rolls drleed since Juno 1915. Community For wells drilled prior to that date, give yell depth ;attach log if availabiol_ Public Utility Sewer Disposal II X6{ Individual Year Individual Installed: Public Utility When Connected to Puhhc Utility: Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED_ 'JUNICI >ALITY Or ANCwonneF DEPANTMIF:' OF 111.-ALIH & ENVIBONIMEN AL i ROTt"C'Vi" -I Finvirontnent it & nitration ['M -ion 1325 I. Sti ,,)t Ant-,lTorarje, Alaska 99509 o 'folophmio 2.64.1,720 p i (J"IT1 1hh1-'�Ip�i/✓A`pI.1_(�� l_/1' ESI )�(i�a Y�{Y;{i�fl'��,��`,� 9 p AND WA) F..Ra ��.:��l.s��..A I '.. 1. Property owner Pees Developmen-L Mailing Address 6917 Old Seward IIigh;,ay z Legal oesrannhor' I Lot 3 Block 1 Kasil.of Hills Subdivision 3. Type of Dwelling 4_ Sr. nage Dl,ixsal 5_ Water Supply XXSingle Family X Individual xMildivlduai Multiple Family Public Wilily Public Other Holding Tank Communis; tsh�c;, 'CONDITIONS OF nPPPC;rAI. APPROVAL FOR , DAA IxTq',.ts L ,. I Lhree Rrr)ij( s R", _ CONDIH ONAL DI SA P P I I;1 VAL .IHIS APPROVE;_ APPROVED V.' THOU_, Lrr'.r rte: -. 720:3 131991 ALASKA Ci 01ROORTAL COnTROL SNUS, InC. Engineerinq & l3nuironmental Studies August 23, 1984 Department or Health and Environmental Protection „) �'� )(l� 825 L Street Anchorage, Alaska 99503 n —ANJ Attention: Robbie Robinson ['/diDwnw Subject: Kasiloff Hills Subdivision, T,ot 3 - Block 1 Dear Mr. Robinson, On August 22, 1984, this office visited the above subject lot and found the wires for the well encased in coizduit. This should satisfy the conditional_ approval. requested January 30, 1984. If you have any further questions, please feel free to contact this office. Sincerely, Ln� 6 .A John W. Gates Engineering Technician Approved By:, Lsfay`Ci, Reild, J , Phd, P.E. Preside _ 1200 West 33rd Auenue. Suite B • Anchorage. Alaska 995039(907) 561-5040 Time APPLIG IT PILLS OUT UPPER HAL DNLY Time Property Owner �) r :�' Date Phone Data Date / Inspector Mailing Address Zip Code Inspector Buyer Address r, i F Zip Code Lending Institution Phone C-O.V N/� ;;-7 N` Address �y �• 'CONDITIONS OF APP VAL Zip Code Realty Co. & Agent-L� ;r /`.r-� ' Phone Address 1!. l F i_ .-`r!P ,.f, -. -\ L�4Zip/Code Legal Description 4>r';r.� f`•, _-� �.-,. ,%.,.., . . Street Location Type of Residence / W -Single Family ❑ Multiple Family No. of Bedrooms— '_ ❑ Other Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal 7A Individual Year Individual Installed: ,b. Public Utility When Connected to Public Utility: _ ❑ Holding Tank NODE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, Time Time Time Time �— Date Dale Data Date / Inspector Inspector Inspector Inspec�l Field Notes: C-O.V N/� ;;-7 N` ( ) APPROVED BEDROOMS ( ) DISAPPROVED �y �• 'CONDITIONS OF APP VAL ( h) CONDITIONAL APPROVAL' DATE � Soils Rating Date Sewer Installed s Well 1'o Absorption Area Well to Tank _ Well L.oy Received Septic Tank Size 2 Uzi IJ,�I ALASKA MUIROWWAL COnTnOL ECRU CB, InC. Engineering & enuironmentol Studies January 30, 1984 Department of Health & Environmental Protection 825 L Street Anchorage, Alaska 99501 Dear Mr. Robinson, On January 25, 1984 1 inspected the sewer system and well located on Kasilof Hills Subdivision Block 1 Lot 3. At that time a water sample was taken. The results are attached. The standpipes are above ground and capped. The well is located 120' feet from the sewer system. The well casing stands 1' above ground surface and has a sanitary seal. The ground was graded away from the well. The wires were not encased in conduit. we request a conditional approval be granted until spring when the ground can be excavated. Sincerely, WIm Green Geotechnical Engineer Approved: �f cJa 3 Le C, Reid, Jr. , 1200 West 33rd Auenue, Suite B • Anchoraqe, Alaska 99503 9 (907) 276-1361 CHEMICAL & G VAL LABORATORIES Of ALASKA, INC. ANCHORAGE INDUSTRIAL CENTER 5633 B Street 4P I' Drink ng Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER II TO BE COMPLETED BY LABORATORY WATER SYSTEM: Ll I I (') See It on back I.D. NO. Water System Name Phone No. Iz Q Ul �� rd f t� _7 76 01; Mailing Address City State Zip Code SAMPLE DATE: ® EM Mo. Day Year SAMPLE TYPE: Al Routine Cl Check Sample (for routine sample with lab ref. Treated Water t 0 Untreated Water CI Special Purposee SAMPLE Time Collected NO. LOCATION Collected By i I k a.41 i 1, 61 Oj z: to s% 2 3 4 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Analysis shows this Water SAMPLE to be: ASatisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. c/ Dale Received Time Received Analytical Method: O Fermentation Tube Membrane Filter Lab Ref. No. Result' Analyst L I EEI LI EEI L_ — I +Noof colonies/100 ml. or No. of Posnrve portions. 05.1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date CoileCted Tim, Raealcael Source A.M. n m_ 1 ah. Nn_ EMB Broth 24 hourf: Broth 4e houril -. MulllPla Tubo Report) 10m1 Tubi$ POSUl"/TOtal 10ml PortloM Membrana Fliterl Direct Count Coliform/100m1 Verit"tlon: LTB SGB_ Final Membrane Fill "uR$ Coillorm/100m1 Reportlate / ,ad F 4/ a.m. n_m_ Municipality of Anchors j4 2)2112-:. On-Site Water and Wastewater Program a " ' (907) 343-7904 E. 2 v. Zl (0l 16 iL`Q Certificate of On-Site Systems Approval Parcel LD. 015-161-07 Expiration Date: 7- l ZS 1 7 1. GENERAL INFORMATION: Complete legal description KASILOF HILLS; BLOCK 1, LOT 3 Location (site address) 11080 Staganof Drive*Anchorage 99507 Current Property owner(s) Cody&Lori Landenburger Day phone 732-586-2617 Mailing address Real Estate Agent Loretta Daniel Day phone 227-4142 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: — Date: tcl COSA to be relea • to the en,+r er, unless otherwise requested by the engineer. COSA Fee $ 5Z Waiver Fee $ Date of Payment Li 0113- Date of Payment Receipt Number 0903-Ap� Receipt Number COSA# ( 2C -1 P� 12! Waiver# 5. STATEMENT CTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: W- 71 oQQo�O�♦ � In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF f• L 04n in accordance with the guidelines and regulations established by the Municipality of Anchorage and P, �,. industry practices. The reported results describe the condition of the system/s on the date/s of the � 4�\ ' VV evaluation. Separation distances were measured to readily identifiable features. Hidden defects or ��, H "..-700 encroachments may exist that were not identified during the evaluation. The operational life of all wells / * . • 9 and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 0 " v groundwater levels (that may fluctuate during the year), quality of construction (materials and 4 � VA 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 !/ J f A. Co�rness, system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of on '•/ j iii � the well or septic system. GEG makes no representation whether an alternative well or septic system .i/ J• �f�'; I f c�0 can be installed on the property in the event either of the current systems fail to perform adequately in 4 c.°o the future. The content of this report is for the sole benefit of the person/party that retained GEG to profess'��(I600 perform the evaluation. Reliance upon the information provided in this report by any other person or ‘�4400�Q" party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for _ bedrooms System #2 Approved for bedrooms \�\� ; IC,SG Disapproved ON-SITE GIT+ Conditional approval for bedrooms, with the following stiOtiAlaiii,ANID WASTEWATER ^ROGRAM • By: Original Certificate Date: LI— (g)—f 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 10.10-12.doc 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 1, LOT 3 Parcel ID. 015.161.07 A. WELL DATA 'SEE CONFLICTING WELL LOG FROM DNR(ATTACHED) Well type PRIVATE If A. B, or C provide PWSID # N/A Well Log (YIN) YES Date completed `9/24/83 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth 245 ft. Cased to 38.5 ft. Casing height (above ground) 18+ in FROM WELL LOG AT INSPECTION Date of test 9/24/83 416117 Static water level 90' ft. 56.7 ft. Well production 0.5 g.p m. 1.2+ g.p.m. WATER SAMPLE RESULTS: Coliform ND colonies/100 mL Nitrate 0.954 mg/L Arsenic ND ug/L Date of sample 4/6117 Collected by: GEG,Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/26111 Tank size 1000 gal Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 770 }i4:, Pumper At >1 eit_ C. ABSORPTION FIELD DATA 'DRAINFIELD UNDERSIZED BY 5% Date installed 9/8183 Soil rating (g.p.d /ft2 or ft2/bdrm) 120 System type DEEP TRENCH Length 20 ft. Width 4 ft Gravel below pipe 8.5 ft. Total depth 17 ft. Eff absorption area '340 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/6/17 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 461 gal New depth 0 in. Elapsed Time 0 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d Any rejuvenation treatment (past 12 mo ) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off level at in. High water alarm level at in. Datum _ 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 field 5'(PER 2013 COSA) Water main 10+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES 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'+ COMMENTS Small portion of drainfield appears to be under the driveway 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 �pp4� Date 4-/f �{!' �— ov� .C, _A 0 • i�rr 1/4igNe .,11 if i'Veg �' ress;o^�c ��Obo��c. COSA brown sheet 10-1 0-12.doc #AECC884 I \ \ Lot 6 Lot 4 \ •U 1 ,_ EAST 185.16' I N 13 r 8, O W /M1 zJ 4 58.5' o o j s,o 20 Well® ,� 0 45 Lot 7 Lot 3 "m ry j 30' j o �. 2 p �' 0 o '7 Existing c z "" House = I 5 Septic Cleanouts (ID ?9i ® } Cn tb Gravel Dri • ve 2 Septic® co `O Cleanouts in WEST 190.00' 30' 1 Lot 8 Lot 2 1 t,QFaAi. N _ '4 _,,if,! ...-..- ,j,...- • �4.P pr.. 49— %\ '.7a 0 . oO 4..: ., .0 1''- 5 0 ji n . Janice M. Zilko . Q Q1 ^ .. LS-8629 •• �°p •4a d o \ArO'ession°t,-do NOTE: -�D�Ooo• — THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. Legal Description: AS-BUILT Ordered By. Janet Dailey/ReMax Dynamic Properties Legend: Lot 3, Block 1, Septic Standppe® Kasilof Hills Subdivision ,ne-X--X SURVEY CERTIFICATION: LANTECN hos conducted a physical survey of the property as shown on thie drawing and certifies that the Improvements eltuated thereon are within the property lines and no encroachments exist other than noted LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS EXCLySIONARy NOTE, It is the owners'responsibility to determine the existence of an armaments. covenants, restrictions or right—of—way takings which do not 440 West Benson Boulevard, Suite 200 Phone: 562-5291 datahf an the recorded subdrvb ct plot under no dratrop,-t us should any Anchorage, Alaska 99503pam hereon p used for conatruMlon for ntablbhing property gnee, a for 1111 Fax: 561-6626 Plot—pan purposes Plot No: 66-96 IGr1d No: 2641 Date: October 16, 2013 'Drawn Br JMZ sMM. f,-d—. 4111♦91 •06• • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 r Parcel I.D 015-161-07 i 1-7 Jr Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: 2`{ KASILOF HILLS BLK 1 LOT 3 11080 STROGANOF DR., ANCHORAGE, AK 99516 Current Property owner(s) RUSSELL MARTIN Mailing address Real Estate Agent 2. TYPE OF DWELLING: Day phone 346-7700 Day phone R Single Family (w/wo ADU) 11r ❑ Duplex RUSH! ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: NONE Distance: --- Received by. I ' , I'A ? Date: COSA to be released to`th ` ngineer, unless otherwise requested by the engineer. COSA Fee $ Lkq0 Lrg'&SA Waiver Fee $ Date of Payment10IJ,3'i5 i Date of Payment Receipt Number 09�iq1 G Receipt Number COSA# 05W)i65 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 SPURKLAND ENGINEERING Phone 279-3916 Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND Date 10/23/13 _:-�% OF-Al� 14 �✓ �w +'Yr l V r" 6. DSD SIGNATURE : ; .: :: ""' "' ' System #1 Approved for bedrooms ARS . SPURKLA^do: f System #2 Approved for bedrooms L Y PP ( �'•. lb�z313.•'F� - Disapproved '`1�i�Oi� Off- Conditional approval for bedrooms, with the following stipulations: By: //i' ✓ A Original Certificate Date: The M o orage 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet E � ., If more than I septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: KASILOF HILLS BILK 1 LOT 3 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID #- Date completed 9/24/1983 Sanitary seal (Y/N) Y Total depth 245 ft. Cased to 37 ft. FROM WELL LOG Date of test 9/24/83 Static water level 65 Well production 0.5 WATER SAMPLE RESULTS Parcel ID: l e /5—'- 1 ( a-7 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 10/14/13 ft. 70 ft. g.p.m. 1.0 9 - p.m - Coliform EG colonies/100 mL Nitrate 1'08 mg/L Arsenic NO ug/L Date of sample: 10/14/13 B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping 6/3/13 Collected by: ANSON MOXNESS Date installed 7126/11 Cleanouts(Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Pumper ONE STOP PUMPING C. ABSORPTION FIELD DATA Date installed 9/8/1983 Soil rating (g.p.d./ftZ or ft2/bdrm) 120 System type TRENCH Length 20 ft. Width 48 ft. Gravel below pipe 8'5 ft. Total depth 162 ft. Eff. absorption area 360 fe Monitoring tube Y Depression over field N Date of adequacy test 10/14/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 525 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date - D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50+ Manhole/Access(Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots100 + Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas100 + SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5'+ Water main NA Water service line 10'+ Wells on adjacent lots 100'+ Absorption field 5'+ Surface water 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main NA Water Service line 10'+ Curtain drain 50'+ (N.O.) Surface water 100'+ Driveway, parking/vehicle storage10 Wells on adjacent lots 100'+ F. COMMENTS *CASING SET INTO BEDROCK. ** BATERIA RE -SAMPLED 10/21/13 G. ENGINEER'S CERTIFICATION I certify that l 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 LARS SPURKLAND Date 9119/13 COSA brown sheet 10-10-12.doc in. Lot 6 Lot 4 0 \ EAST 185.16' I N A� CA o 0. zf 58.5' o � 4 ° ® in o s,o 20 Well Lot 3 O 30• to Lot 7 w 4.7 N Z3 2 T n O 2.p O —h Existing 0 o Os N M� House = I 5 Septic OO 28'4 Cleanouts ami <• CD 01 Gravel Drive, �. 2 Septic® Cl (6 WEST 190.00' 30' Lot 8 I Lot 2 _Q000�pp AC"9`S`��� Qo�P•��.OF p°O ? 49TH p....... °op.A.. .�.� V OQ9 •, Janice M. Zilko LS-8629 •' p �AfOfessiono\ ��OOpoo�� NOTE: THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. Legal Description: Ordered By. Janet Dailey/ReMax Dynamic Properties AS-BUILT Legend: Lot 3, Block 1, Septic Standpipe OS Water Well ® Kasilof Hills Subdivision Fence—X—X— Ove hang Wood Deck�i SURVEY CERTIFICATION: LANTECHi has conducted a physical the property as shown on this drawing and prove a es that the Improvements situated LXMZ"&MC.r1 thereon are within the property lines and no encroachments exist other than d no noted. EXCLUSIONARY NOTE: It is the owners' responsibility to determine the existence LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS of any easements, covenants, restrictions or right—of—way takings which do not 440 West Benson Boulevard, Suite 200 Phone: 562-5291 appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction, for establishing property lines, or for Anchorage, Alaska 99503 Fax: 561-6626 plot—plan purposes. Plat No: 66-96 lGrid No: 2641 Date: October 16, 2013 Drawn By. JMZ Work Order: 2013L164. Ref: 83—L-372 Scole: 1"=40' Checked By.