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HomeMy WebLinkAboutKASILOF HILLS BLK 4 LT 21���s SC C\,rt, (, ts l ry g.0m f2-0 W I-S-5 W�C-L Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221097 PID Number: 015-131-11 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑■ Two Single Family Project: ❑ New 0 Upgrade Name MacCormack Leman Living Trust ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 10700 Rezanoff Cir, Anchorage, AK 99507 ❑ Other Phone 907-830-2379 Number of Bedrooms 3 Rating Total depth from original grade GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe in from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Kasilof Hills 4 21 Fill added above original grade Gravel length Township Range Section Ft. Gravel width Ft. Beds: Number of Line I Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. betwe renches From Tank Field Tank Line Ft2 t. Well >100' N/A N/A N/A >25 TANK ❑� Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water >100' N/A N/A N/A Material PLASTIC Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation 1>1o, N/A N/A N/A L ATION Manufacturer Capacity Remarks Deck adjacent to the tank is less than Gal. 30" above grade. Alarm location Electra �by Installer PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 A.C. E.S. Drainfield N/A CO/MT N/A Inspector L.Tidwell BENCH MARK (Assumed elevation) 100 ft Inspdection 15` 5/7/22 2na 5/7/22 Location and description 3fd BOTTOM OF SIDING 41h ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date ' • ,4tS,� , .49 TH . d .. '• • Benja . Schiller Septic System I Approved Date 1 �' �y � .• i�`�r' �� �F� •. CE 125925/31/22 �pROFESSIONP�'�.��� Note: this approval does not Include well permit requirements. 10. nG/nn/4 ON t\\��"��•► 11�lYiliii�Y/ PERMIT # OSP221097 PID # 015-131-11 WELL & WATER LINE EASEME�T (DOC NO 1988-042021T0) J LOT 21 r 33/ EXISTING ABSORPTION ` f �� TRENCHES TO STAY 0 IN SERVICE t —n f� LOT 23 LOT 23 WELL IS 1000-GAL >100' FROM SEPTIC TANK — f i PROPERTY LINE ` W/ 20" MANWAY/ L 1 10' UTILITY EASEMENTS t 20' C.E.A. EASEMENT (DOC NO 1985-031742-0) r RIE, AINIAG WALL 3-BDRM HOME tMH _ SHE6`�CK LOT 20 ' — A B K129.4 6.4 17.0 21.9 X 1 0.4 1 23.9 Cr `®t� LEGEND ®,�P' • • • •�•f- 0� CO - CLEANOUT .49 1H 'DPP PLAN Vn' AS —BUILT 2C0 -DOUBLE CLEANOUT • • �-•OFCO - FOUNDATION CLEAN( -•� , 0 50 100 FS - FLOW SPLITTER VALVE Benja i Schiller iIIIE ME FEET MH - MANHOLE !��'Fc,�'• C eia�i92 .•' �®®® 1"=50' MT - MONITORING TUBE ���>�F�PROfESS10N* SV - SEPTIC VENT TH - TEST HOLE .ram n ram. PERMIT # OSP221097 PROFILE AS -BUILT (NO SCALE) PID # 015-131-11 TH e�ge�g,. • �.. �—. ••'.,BenjaSchiller •' '•..'. CEirzz92,���� ESSIONP \ n O O N Lot 23 n 'c c i 10' UTILITY-\� EASEMENTS �i' WELL & WATER LINE EASEMENT (Doc. No. 1988-042021-0) MANHOLE-/ !_ DECK 10.3'x12.2' SHED IS t� 70 1 S 8 1 •34'39"AN 165.00' t 3� 20' C.E.A. EASEMENT ti Ii I (Doc. No. 1985-031742-0) Lot 24A I I I Lot 20 I PLOT PLAN ___ AS BUILT _X_ SCALE 1" = 40' GRID SW 2541 — Project Na 22-2001A2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone (907) 522-4625 Fax Professional Land Surveyors ken®langsurvey.com o OF A, 4 h 4 jonathon0langsurvey.com 0'` .••'•• ''•.'9s D I hereby certify that I have surveyed the following described property: LOT 21, BLOCK 4, KASILOF HILLS SUBDIVISION (PLAT No. 66-96) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the _?�Day of---_G?2'� � at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH v KENNETH G. G ...... 0 '..LS- 202. O AR ••......••' NOo 44�� �FfSSIONAG AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221097 Work Type: SepticTank Upgrade Tax Code Number: 01513111000 Site Legal Address: KASILOF HILLS BLK 4 LT 21 G:2541 Site Mailing Address: 10700 REZANOF CIR, Anchorage Owner: MACCORMACK LEMAN LIVING TRUST Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: pcnt n J Departine nt 5/2/2022 5/2/2023 33000 Disposal Field Q Septic Tank Holding Tank Privy Private Well Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Date: s-/ 2 3 U li t1 � C � tl— !� d ®!J H �3 kl�l1® 6=e1G Community Development Department h 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. 015-131-11 Property owner(s) MacCormick Leman Living Trust Day phone 907-830-2379 Mailing address Po Box 110169 Anchorage, AK 99511 Site address 10700 Rezanof Cir Anchorage, AK 99507 Legal description (Sub'd., Block & Lot) Kasilof Hills B4 L21 Legal description (Township, Range & Section) Lot Size 33,000 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x Septic Tank ❑x Upgrade ❑x (w/wo ADU) (D) ❑ Holding Tank E]Renewal ElDuplex 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. (Signature of property owner or authorized agent) Permit/Rush Fees: k ZZ g Waiver Fees: Date of Payment: c/AZ�E Z Z Date of Payment: Receipt Number: 0-93Z 3 ,D Receipt Number: Permit No. OS 1927- /09 % Waiver No. Permit App_'.:- : - April 27, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Kasilof Hills B4 L21- 10700 Rezanof Cir. Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the well and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. The new septic tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the absorption field, and adjacent deck. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221097, Deb Wockenfuss, 05/02/22 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' EXISTING ABSORPTION TRENCHES TO STAY IN SERVICE 1000-GAL SEPTIC TANK W/ 20" MANWAY MAINTAIN >5' SEPARATION FROM DECK CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO KASILOF HILLS, BLOCK 4 LOT 21 FEET 0 50 100 NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS.REZANOF CIRCLE3-BDRM HOME 4/26/22 WELL & WATER LINE EASEMENT (DOC NO 1988-042021-0) RETAINING WALL 10' UTILITY EASEMENTS DECK SHED 20' C.E.A. EASEMENT (DOC NO 1985-031742-0) DECOMMISSION EXISTING TANK PER UPC L0T 23 WELL IS >100' FROM PROPERTY LINE L0T 24 WELL IS >100' FROM PROPERTY LINE 2CO Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221097, Deb Wockenfuss, 05/02/22 n � I I\ I I I I z 0 Lot 23 I I I 10' UTILITY I EASEMENTS II Lot 22 I WELL & WATER LINE EASEMENT (Doc. No. 1988-042021-0) N 61'34'39"E 165.00' NEIGHBOR'S SHED \- SEPTIC PIPES I I N I O O I Lot 21 33,000 S.F. oe` N i QIP 0 - -- RETAINING WALL O p I 2.1'x5.4' CANT 27.0 I 60.3' N SEPTIC PIPES 2 STORY I RESIDENCE 27 T s. I I � DECK I Lot 24A 10. .2' SHE ffl 1 X20' C.E.A. EASEMENT (Doc. No. 1985-031742-0) Lot 20 i I I WELLS I i I PLOT PLAN ___ AS BUILT _x_ SCALE _1� -_ 40-_ GRID _ SW 2541 __ Project No. ____22-2001A1____ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & A s s o c i a t e s in c. (907) 522-6476 Phone (907) 522-4625 Fax o00 4 4 Professional Land Surveyors kenolangsurvey.com o, ,9n jonothan®longsurvey.com O O n S I hereby certify that I have surveyed the following described property: LOT 21, BLOCK 4, KASILOF HILLS SUBDIVISION (PLAT No. 66-96) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. obi � Dated this the __Iq ___ Day of -- LLLLL!:_ _- at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH �* �NETH. ..N .. ..N ... ¢. .LS -5202.'' gJOG �QnR�FfSS10NA1- �o AECC963 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 MAILING ADDRESS .4 13o× LEGAL DESCRIPTION DISTANCE TO: Well I~~O~'' / I Absorptionarea.~.,.~_3! DwellinI Material IF HOMEMADE; Inside length ] Width Liq, DISTANCE TO: Well PHONE [] NEW DweJling Manufacturer Material Nearest lot linc, DISTANCE TO: Well l ("~ ~)q--/ / l() / No. of I,,L~s Length of each lice )li2es ] Tronch~,~t~ Top of tile to finish Material beneath tile ~ ~¢ inches Length Width Depth NO. OF BEDROOMS No. of com. Tzr. r_tment Liquid depth PERMIT NO. Liquid capacity in gallons Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: DISTANCE TO: Depth Driller Distance to lot line PERMIT NO, Building foundation Absorption area(si OTHER PIPE MATERIALS Sewer LEGAL L ':24 SOIL TEST RATING REMARKS APPROVED DATE Septic tank ALASKA r dlROFIm F1TAL COFITROL SE![4uICeS, IFiC. ~nqin¢¢rin(I $ ~,uironm¢,lal Studies SPECII?ICATION8 FOR FIVE-WIDE ALTERNATIVE WASTEWATER TREATMENT SYSTEM- LOT 21, BLK 4, KASILOF HILLS SUBDIVISION 1.0 GENERAL 1.1 THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION, 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, THE CONDTIONS OF THE PER~IT, AND ALL APPLICABLE RULES AND REGULATIONS CURRENTLY IN EFFECT. 1.3 ALL EXCAVATIONS AND DEPTHS ARE ~)VISORY AND ARE TO BE VERIFIED OR MODIFIED IN THE FIELD BY THE ENGINEER. 1.4 IT IS THE RESPONSIBILITY OF THE OWNER OR INSTALLER TO OBTAIN ALL NECESSARY PERMITS, EASEMENTS, OR WAIVERS REQUIRED FOR INSTALLATION OF THE SYSTEM. 2.0 SEPTIC SYSTEM 2.1 THE SEPTIC TANK SHALL BE A UPC APPROVED TWO COMPARTMENT TANK, SET LEVEL, AND INSULATED WITH AN OVERLYING LAYER OF 2" BURIAL TYPE POLYSTYRENE. THE SEPTIC TANK SHALL REST ON UNDISTURBED SOIL. 2.2 INLET AND OUTLET PIPING SHALL BE FITTED WITH WATER- TIGHT CALDER COUPLINGS. PIPING SHALL BE 4" SOLID PVC SLOPED A MINIMUM OF 1/4" PER FOOT, WITH A MINIMUM OF 4 FEET OF COVER. IF LESS THAN 4 FEET, USE 1" OF POLY- STYRENE FOR EACH FOOT OF COVER LESS THAN 4 FEET. 2.3 CLEANOUTS SHALL BE INSTALLED WITH CALDER COUPLINGS, CAPPPED WITH AIR-TIGHT JIM-CAPS (OR EQUIVALENT), AND EXTEND A MINIMUM OF 3 FEET ABOVE GROUND LEVEL. 2.4 THE SEPTIC TANK SHALL BE A MINIMUM OF 5 FEET FROM THE HOUSE FOUNDATION, AND HAVE A MINIMUM OF 5 FEET BETWEEN THE TANK AND DRAINFIELD. 3.0 DRAINFIELD SYSTEM 3.1 TIlE GRAVEL FOR THE BED SHALL BE SIZED BETWEEN 0.5 TO 2,5 INCH ~ND FREE FROM SILT OR SAND. 3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN COMPACTED DURING EXOAVATION. THE BOTTOM ELEVATION SHALL BE PLUS OR MINUS 2" WITHIN LEVEL. 3.3 THE DISTRIBUTION PIPE SHALL BE 4 INCH RIGID PVC OR POLYETHYLENE. THE PIPES SHALL BE LAID LEVEL. 3.4 AN OBSERVATION PIPE SHALL BE PLACED AS SHOWN IN THE DRAWINGS. IT SHALL BE RIGID PVC, ASTM 3033 D-3034. THE SECTION BELOW GROUND LEVEL MAY BE EITHER DRILLED 0,5" HOLES @ 6 INCH CENTERS ON OPPOSITE SIDES OF THE PIPE OR A REGULAR SECTION OF PERFORATED DISTRIBUTION PIPE MAY BE CLAMPED TO THE SOLID SECTION WITH A NO HUB COUPLING OR SOLVENT JOINT. A RUBBER RAIN-CAP (JIMCAP OR EQUAL) SHALL BE PLACED ON THE TOP THE PIPE. 1200 LUcsl 33rd Aocnu¢. SuJl~ ~. Anchoro§¢. Alaska 99503,(907) 561-50~40 3.5 THE GRAVEL SHALL BE COVERED WITH A LAYER OF UNTREATED BUILDING PAPER, A NONWOVEN FABRIC (SUCH AS MIRAFAR FIBRETEX 200 GRAOE, POLY-FILTER X, OR EQUAL.), OR A LAYER OF VISQUEEN. 3.6 IF INSULATION IS USED RATHER THAN MOUNDED BACKFILL, THE INSULATION SHALL BE DOW EXTRUDED BLUE STYROFOAM BOARD OR ARCO GEOFOAM EMBANKMENT IN$ULATION BOARD OF THE REQUIRED THICKNESS (1" PER FOOT OF SOIL LESS THAN 4 FEET OVERLYING THE BED). THE SOLID PIPE EXTENDING FROM THE SEPTIC TANK TO DRAINFIELD SHALL HAVE 4 FEET OF COVER OR AN EQUIVALENT LAYER OF INSULATION TO PRE- VENT FREEZING OF THE LINE. 3.7 THE TOP OF THE BED SHOULD BE PLANTED WITH A WHITE CLOVER AND RED FESCUE MIX. 3.8 IT IS CRUCIAL THAT CARE BE TAKEN IN CONSTRUCTION OF THE FIVE-WIDE TO ENSURE PLACEMENT INTO THE PROPER SOIL STRATUM FOR PROPER OPERATION OF THE SYSTEM. E:Edq TI::IC"f' F'I...I O i'-,I E:: I E: E: I:4'. "I" t I:':'"r' 'FHI::I"t": :.1...:1:i::I1¢1 [::'¢::li'ltL. I t::li:;;: H:['T'H THE FOR"I"H li!!~'T' 'THE: HI.JH I E: I F'!:::ti.... i ;;.~. ! !,.! :!: t...I .. IH:~FTI::fi....i.. "r'HE !;_:;'.¢:i;i"E:H IH t;:If.,t[;, :!: t'.,! COI','IF'I... i !::tHE:E I,.i :1: 'I"I..I 'TIE [::,E:ii; I EiI'.,I E:i'~;: I 'I"IER I 1::1 ELF:' TH :[ :..'..!; [::'liii:t:~:l,'l ::~:. :1: !.,.tlL. L. t'::ll)l...IE,:;i:li!: "r'o ]::iL.I... HOI::I (::li'.,li:::, t:::, Z :~i;'TI::II'..ICE'.:i; I::;'l:~:l::)i"! f:ii'.,!'.r' IE',:.:: I :!;!' i !i!;E:!,.i[.i[;;:I::IGI:![ :.:['.~.':!!;']"EI'I Eli'.,i '!'ii!ill; Oi:;;: !:::IH'.~.' t::lii:,.jl'l::lE:l:ii:i.,i'T Eli:;;: i",lE:i::lF4:li!i¢'r' L. Eri". MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmenta: ~r°t~c~)~°~'l 825 ', Street, Anchorage, AK. ~950~? )~' '~.- ~' . · · ¢~/~c'-'~> HANDWRITTEN PERMIT //( ~erm~t ~ ~-"/c~¢ WELL AND/OR ON-SITE SEWER PERMIT Trench: Drainfield: .~_ Seepage ~d: Holdmng Tank: Maximum Number of Bedrooms: ~ Soil Rating (sq. ft/br) ,/~ The Required. Size of the/Soil Ab~¢/~bn System Is: DEPTH /',-~ LENGTH /~ . GR~BCDE~TH, , O' WIDTH '-- _ The ~ength dimension is ~ne leng~:~nv=eet) o:/ t~e ~rencn or ~ra~n~e~. 'ne 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 minim~ depth of gravel between the outfall pipe and the bottom of the excavation(in feet). ~ ~ REQUIRED SEPTIC(HOLDING) TANK SIZE = /~/3 6ALLONS Permit applicant has %he responsibility %o 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 we:L1 depending upon the type of public well. Minim~ distance from a private well to a private sewer line is 25 feet and to a co--unity 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 3~, 1 9 (1) I ~ f~iliar with the requirements for on-%ite sewers ~nd 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 r~sidence is remodeled to include more¢ ¢/that 3 bedrooms. S igne~: ,:y~.~;~/./2~-~/ I s s u ed by: ~¢.(/~ ,.~.->-,~/ Applicant / MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4 7 DATE PERFORMED: ~=/2¢~: SLOPE SITE PLAN 10 11 12 13 14 15 16 WAS GROUND WATER y.'t~.~ ,.~" SL ENCOUNTERED? O P f IF YES, AT WHAT ~ '~' E DEPTH? q" d ~mc~e¢' Gross Net Depth to Net Reading Date Time Time Water Drop +//z0 £/~7~ /":' q t~/,..k,,. , ,,/:54 ,zc~' /.'1'-/ , 0~- -- .-,,J ./~ . .t'f- PERCOLATION RATE · / T BETWEEN ~"~ AN ; ¢.~ ,, I BY' ' , g';' ~ j .+q ~ e' ',DATE ST95- ozq .... .'. ---' 72-008 {6/79} 'k.; ALASKA ENVIRONN~ ~TAL CONTROL SERVICES, INC. ].200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 SHEET NO. ~ OF CALCULATED 8Y ~ DATE CHECKED DY DATE SCALE ALASKA ENVIRONM .rAL CONTROL SERVICES, INC. 12C0 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 276-1361 JO~--~ CHECKED BY DATE SCALE W WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8k Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either la, Ib or Ic.) A.D.L. No. la. Borough Subdivision Lot Block Ib. V4gIrs. Section No. Township N� Range EE] Meridian _of_of—of— SO WE] Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Address: Street Address and Area of Well Location 2. WELL LOG Feet Below Surface Material Type Top Bottom 4. WELL DEPTH: (final) ft. 5. DATE OF COMPLETION — — 6, []Cable tool Rotary [] Driven Dug E]Auger Jetted 0 Bored C] Other: 7. USE: [] Domestic E] Public Supply Industry E] Irrigation Recharge Commerical Test Well Other: 8. CASING: C] Threaded [-] Welded diam. in. to ft. Depth Weight lbs./ft. diam, in. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type: Diameter Slot/Mesh Size: Length: Set between ft, and ft. Backfilling Gravel pack �^( OF �NP. DF-PTORO EC110 EN�I,O 10. STATIC WATER LEVEL: ft. Above or [] Below land surface Date Equipment used: II . PUMPING LEVEL below land surface and YIELD ft. after hrs. pumping 9— p.m-ft. after hrs. pumping g.p.m. 12.GROUTING Well Grouted: L] Yes [] No Material: O Neat Cement E] Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. Subm. Jet [:) Centrifical Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature ° E] F O C This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; Registered Business Name Contract License Number Address: Signed: Date: Authorized Representative Form 02-WWR (11/81) Copy Distribution: WHITE-Stote DGGS, PINK -Driller, CANARY -Customer C N G) r - o0 Z a MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMEN'I~AL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF.' ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section,'township, range) Lo;¢ 21; B£no~ ,¢; ~,~J£nf HJ££ Location (address or directions) 10700 gesanof Drive, Anchorage, Alaska (b) Property owner Mailing Address (c) Lending Institution Mailing Address ,~ ....~,- :*~-* Telephone: (home) I¢700 Resanof Drive, Anchorage, AK. 995~6 Business Telephone (d) RealEstate Company and Agent JACK WHITE COMPANY ATTN: Kay England Address 3201 C Street, Suite 100, Anchorage, AK. 99503 Telephone 563-5500 (e) Mail the HAA to the following address: (or check herek~, if hold for pick up.). List contact person and day phone number below: S & S ENGINEERING Eagle River, Alaska 99577~. 2. TYPE OF RESIDENCE Single-Famil'~ Number of bedrooms 3 3, WATER SUPPLY Individual Well,Q[ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of thevalidationdateshown below, Iverifythat 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 disposaJ system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address S & S ENGINEERING Date 17034 Eagle River Loop Road No, 204 Eagle River, Alaska 99577 6. DHHS APPROVAL Approved for ,~ bedrooms by 'Approved ~ _Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 DHHSdo not conduct inspections or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsibleforerrorsoromissions in the professional engineer's work. 72-025 (Rev. 7/88) Bacx Page 2 of 2 ML~IC/~,V~C~.~[~C,C~ALITY OF ANCHORAGE/MOA) ~Nv~gON~ Health Authorily Approval (HAA) ~ CHECKLIST- FEBRUARY 1984 /L~ }'~ ~9=., 343-4744 A. WELL DATA Legal Description: If A, B, C, D.E.C. Approved (Y/N) I~/'t'~ Yield Pump Set At ¢:~ r~ Sanitary Seal on Casingd~) ~/ Depression Around Wellhead (Y/J:~ Well Classification Well Log Present ~N) "-/ Date Completed Total Depth_~;~'~ C, ased to~-'~'/ Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~C~/N) _ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on IrOt To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ~f' Water Sample Test Results Comments ~ (_.~5~'~¢ it....~q-~D %~1~-~--~--.~¢-~-. ; On Adjoining Lots \'~c>lct'- ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SFPTIC/HOLDING TANK DATA Date Installed~\"]--~--~r Size_l ~ Standpipes 4:~N) ~ Air-tight Caps C/N) Depression over Tank (Y~:j:) r-5 Pumping/Maintenance Contact on File (Y/N) / Holding Tank High~Water Alarm (Y/N) -fA//~' SEPARATION DISTANCES FROM SEPTIC/H©LDiN(~:--~ANK: No. of Compartments "-/ Foundation Cleanout (d~N) /Date Last Pumped ~) ; for ¢/¥4 Temporary Holding Tank Permit (Y/N) To Building Foundation ~ ~:> To Disposal Field To Water-Supply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/86) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~;~ '"~ \ '~ Width of Field ~ Length of Field ~ ~-~ I Depth of Field Gravel Bed Thickness Square Feet of Absortion Area ~:;~-~ Statndpipes Present ¢~N) Depression over Field (Y,~ ~ Date of Last Adequacy Test Results of Last Adequacy Test ~¢"1~-1 ~-.~~ ~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~. ~ t"~r~ To Property Line To Building Founda, tipn \dc;:~ To Existing or Abandoned System on Lot I'~/''~' ; On Adjoining Lots To Water Main/Service Line I ~;;;~I ..~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~ To Driveway, Parking Area, or Vehicle Storage Area ~ Type of System Design 't~;;~1"~ ~ ~ 11 Comments D. LIFT STATION D ed Size in GalTO'n-~. "Pump On" Level at % High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~'"~---~- . ~Vent (Y/N) ~'~'--'"PL!'mf~g.~C~ring Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. Signed S & S ENGINEERING ~,~ 17034 Eagle River Loop Road No. 204 ~'~ Company ,-_.~_ nl 72-026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 October 12, 1989 ROBERTSHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST ,~ PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Ms. Susan Oswalt Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 21; Block 4; Kasilof Hills 10700 Resanof Dear Susan, FOR YOUR FILES MUNICIPALITY OF ANCHORAfJt~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 0C [ 1 ,'5 RECEIVED There exists a second well on the referenced property located to the north of the well which currently serves the property. This north we~ serves Lot 23 located to the west of the referenced property. To the best of my knowledge their are no recorded easements between the two properties assuring the owners of Lot 23 continued use of the well located on Lot 21. However, both wells are equipped with well seals; drainage is directed away from the wells; and they are located over 100 ft. from any source of contamination. If you have any question, please contact me. Sincerely, ROGER J. SHAFER Civil Engineer RJS/gm MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & EIqVIRONMENTAL PROTECTION RECEIVED 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES OF ON-SITE SEWER AND WATER FACILITY 264-4744 App,cat on Date Iq:' GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Fl.. ~ ~ ~ -' . ' ' ' ' Location (address Or directions) . , Mailing Address '%~¢~ (c) Lending Institution ~' ~'& ~ ~ Telephone (e) Mail the HA~to the foHow~n~ admess: or: Check here~ if hold ~or pic~ up List contact person and day phone number below. '" -17034 Eagle River Loop Road NO, 2(~. . Eagl~ River, Alaska 99577 2. TYPE OF RESIDENCE '; · Single- F~ mi'ly tier'. : · Num6br of Bedrooms' ; wATER SUPPLY Individual WellJ~' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, 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. Page 1 of 2 72-025/Re,., 8'861 Front 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 $ & $ FNGINEERING Address 17'034 Eagle River Loop Road No. 204 Eagle RAver, Aiaska ~9577 Date Telephone DHHS APPROVAL Approved for ~bedrooms by Approved //X~ Disapproved Terms of Conditional Approval Conditional CAUTION 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. Page 2 of 2 72-025 (Rev 8/86) Back MUNICIPALII¥ OF ,",NCHORAGE ENVIRONMENfAL SERVICES DIVISION MUNmmAUT¥ OF ANCHORAGE (MOA) ~ i.c~LTH AUTHORITY APPROVAL (HAA) --~ CHECKLIST- FEBRUARY 1984 264-4744 RECEIVED Legal DesgriptJon: [.-~>~C WELL DATA Well Classification __~ ~ ~t k/~ F~C.'),~"L, If A, B, C, D.E.C. Approved (Y/N) Well Log Present(~N) V Date Com/pleted (--,~ - ~' ~--~ Yield Total Depth \ ~:L.-~/ Cased to''/~'¢~'¢¢ Depth of Grouting Static Water Level ~ .~ I Casing Height Above Ground Electrical Wiring in Conduit <¢~7N) Separation Distances from Well: To Septic/Holding Tank on Lot Y Pump Set At '~ ~ / Sanitary Seal on Casingd_!_~) '7" Depression Around Wellhead (Y~ /'/ 1 ~ '~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot \ d:2¢ t/¢ ; On Adjoining Lots To Nearest Public Sewer Line ~ /~'" To Nearest Public Sewer Cleanout/Manhole ~ / ~ To Nearest Sewer Service Line on Water Sample Collected by ~'~ ~"~-~t¢'3~~-'r~¢' ;Date Water Sample Test Results .~---~,¢~f"¢' ~ "~ ~'~ ~~ Comments ~ (_~¢>,¢/'~.~:2 ~ ~ ~. ~, ,,.~¢~-<L.~L~ ~.~ B. SEPTIC/HOLDING TANK DATA Date Installed ~'¢\'~ ~ Standpipes~.~/N) '7/ Air-tight Caps ((~¢/N) Depression over Tank (Y/(~'}P Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Ho'Itel Tank: To Water-Supply Well ~ ~::A:::P To Property Line \ To Water Main/Service Line \ Course \ ~¢;' Size '~ ~ No. of Compartments '-7/_ Foundation Clean o u tc(.-Y'ZCN) "7/ Date Last Pumped "~ ~-'2~(:2) ¢ ~_.~_2 'for .'~./ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72 026 fRev B 861 Fron~ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness \ Square Feet of Absorption Area ¢_~t,~"~.....- ¢P' Standpipes Present(~'N) Depression over Field (Y/~ ~J Date of Last Adequacy Test Results of Last Adequacy Test ~/¢~"I~ S~ ~'~~ Separation Distance from Absorption Field: To Water-Supply Well '~ ~::;;~ To Building Foundation \ Lot ~ /~ To Water Main/Service Line ~. ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area \ ~ Comments b' To Property Line To Existing or Abandoned System on ; On Adjoining Lots '"--~ To Cutbank (if present) Date Installed Size in Ga High Water Alarm Level at Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Tested for 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 $ & $ ENGINEERING [~1~ 17034 Eagle Ri~er Loop Road No. CompanEagl~4~.!¥e_,,; Alaska 995~ MOA No, ~ ~ ~O ~ Receipt No. ~; ¢ ~O ¢ Date of Payment Amount: $ Page 2 of 2 72-026 IRev 8 861 Back MI/NICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL ~iEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE General Info,nation Application Date'_/~_~. ~'~ 1. (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name~-~ />Zz/~z~,.~:.~..~ Telephone' Home Busines~:~<:~: Buyer ~ ; Other [2]~ (explain>; (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. T~ype of Residence Single-Family Number of Bedrooms 3o Water Sup_p~l~_ !ndiv:[dual Well Multi-Family Other (describe) Community F~--~ ~ Puol..c 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 ~>-~__~ Publ~c Eli:-] Community ~]--'-t Holding Tank 21--~ Note: If community well system~ must have written COrLfirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] En___gjneering Firm Providing Ins_~pections, T~.s_t_s, F~i].__e 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, function~ and adequate for the number of bedrooms and type of structure indicated herein~ I further verify that, based on the info~ation obtained from the ~nicipality of Anchorage files and from my investigation and inspection~ the on-site water supply and/or v~stewater disposal system is in compliance ~th ~1 Municipal and State codes~ ordinances, and regula~- tions in effect on the date of this inspection. Name of Date (ENGINEER SEAL ) DttEP A_p~p_proval Approved for bedrooms Approved .~_~ Disapproved Terms of Conditional Approval Conditional CAUTION THE I,fUNICIPALITY OF ANCHOPukGE DEPARTMENT OF tIEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY ~?PROVA_L CERTIFICATES BASED SOLELY UPON TRE REPRESENT- ATION$ GIVEN IN I?ARAGP~PH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN TRE STATE OF ALASKA. TIRE DItEP D~ES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE P. EQUIRE- MENTS~ ~MPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE i$ ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK° RR4/ej/D18 [Page 2 of 2] (DHEP SEAL) 7-19-84 ae WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification ]~/f ~'u/4~-~ Well Log Present (Y/N) Total Dep%)~ ///~) / Cased to Static Water Level Legal Description: ~ ~_ I ,~ ~ If A, B, or C, D.E.C. Approved(Y/N) Date Completed Yield~[__. Depth of Grouting Pump Set At Casing Height. Above Ground ~ ~/' Sanitary Seal ~ Casing ~/N) Electrical Wiring in ConduitS) Depression Around Wellhead (_Y.~ Separation Distances f~.cm Well: To Septic/Holding Tank on Lot fOO~ ' 09 ' ; On Adjoining Lots ~ /DO To Nearest Edge of Absorption Field on Lot /00~1(~; On Adjoining Lots ~/O¢~ To Nearest Public Sewer Line _ AT/~ To Nearest Public Sewer Cleanout/Manhole ~j/~ To Nearest Sewer Service Line on Lot Wate~ Sample Collected By z~- GO (~ _; Date / Water Sample Test Results ,~xj~.~x~.~)' B® S.EPTIC/HOLDING TANK DATA Oate nstalled Si e Standpipes ~N) Air-tight Caps~N) Depression over Tank (Y~ Date Last Pumped No. of C,c~partm-~nts Fcundation Cleanout ~/N) Pumping/Maintenance Contract on File (Y/N)/~,/;~ ; for Holding Tank High-Water Alarm (Y/N) /u'/l% Temporary Holding Tank Permit (Y/N)~7/_~ Separation Distances fr~ ~ptic~olding Tank: To Water-Supply ~11 /~O+ ~ To ~to~rty Li~ ~) To Water Main/Servi~ Line Cour~ ~j /~ To Building Foundation /0' To Disposal Field I ~ 3~ To Stream, Pond, Lake, or Major Drainage Receipt ~ Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/; 7/~ Width of Field .~-' Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test j~7~! Type of System Design~l~-OJ;~Z~ Length of Field /~(T) __ Depth of Field Gravel Bed Thickness ([D~.~-' Standpipes Present ~N) Date of Last Adequacy Test Separation Distance from AbsorPtion Field: To Water-Supply Well ~ OO.~; To Property Line To Building Foundation /~' To Existing or Abandoned System Lot /%3///4 ; On Adjoining Lots TO Water Main/Service Line _ ~//~ To Cutbank(if present) /D/~%, To Stream/Pond/Lake/or Major Drainage Course /l~ To D~iveway, Parking Area, or Vehicle Storage. Area ~) Comments De LIFT STATION ~ /~/qim~/~ ~/j~ole/Access _(Y/N) ~ "Pump Off" Level at High Water Alarm Level at// Vent (Y/N) Tested for / Pu~mping ' equacy Test. Electrical Co/d~/N ) ~d Comments Date Installed Size in Gallons "Pump On" Level at ~eets ~VOA Check Permitted Bedrocm Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidelines on the date of this inspection. //U C .,, MOA NO. KB1/dS/s [Page. 2 of 2] in effect ______ Date 2-15-84