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HomeMy WebLinkAboutKASILOF HILLS BLK 5 LT 1AKasI*Iof Hills Block 5 Lot 1 A #015-133-27 Municipality of Anchorage © Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Pagel of 2 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWSW111255 PID Number: 015-133-27 Name: Marshall & Annie Talbert Wastewater System: E] New ®Upgrade Address: 10340 KaSilnf Rlyfj 99507 ABSORPTION FIELD Phone: Number of Bedrooms: 0 Deep Trench 0 Shallow Trench 0 Bed 0 Mound 0 Other: LEGAL DESCRIPTION Soil Rating: nPnrFtr Total Depot from original grade: Block: Lot: Subdivision: Depth to pipe bottom from original grade: Fill added above original grade: Gravel depth beneath pipe: Gravel Length: Township: Range: Section: Well: El New El Upgrade Gravel width: Number of lines: Distance between lines: Classification (Private, A, B. CJ: Total Depth: Cased to: Total absorption area: Pipe Matenal: Exist'g Private Ft. Ft, F' 3034 PVC Driller: Date Drilled: Static Water Level: Installer: - Date Installed: Ft. A+ Home Services 10/11/2011 Yield: I Pump Set at: Casing Height Above Ground: TANK GPM FL Ft. SEPARATION DISTANCES ❑ septic ❑ Holding ® S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ubhc/Private Manufacturer: Capacity: From Tank Field Station Tank Sewer Line Anchorage Tank 1500 G.I. Well 106.9 102.7 115 Material: Steel Number of Compartments: 2 Surface Water 100+ LIFT STATION Lot Line 10n+ 10+ Size: 250 Manufacturer: Orenco Gal. 38 45 "Pump on- level al: 'Pump off level at: High wateralaon at: Foundation +40 In. +36 in. +45 in. 50+ 50+ V Pump Make & Model Electrical Inspections performed by: Curtain Drain P2005 Gal rppn Remarks: Exist' tank &lift station abandoned per code. BENCH MARK Location and Description: Back Deck - Assumed Elevation: 100.0 Ft. Engineer's Stamp �4W.•' Inspections performed by: PES. LLC Dates: 1at10/11/2011; gTH ■.....5. .. ................U....� 2"x10/11/2011 i Development Services Department approval p p pp " .............. """""""•• '' ■ �♦ :Steven R. Pannone' �/ Conditional Approval by:Date: �1� C0. E 8149 ♦� Reviewed and approved by: Date: /D- �•��� IE�'C v 61//11 EXISTING COMPROMISED A, /1OOOg SEPTIC TANK AND 300g LIFT STATION ABANDON PER CODE 106. F HOUSE INSTALL 150Dg S.T.E.P. TANK (N) 102.7 DRAIN FIELD (E) SEPTIC AREA (E) TID (400SF) ADEQUATE FOR 4 BR SHED�' MT / ' / / / / �o�o r-- / NOTES: RECORD DRAWING LLC P.U.BOX lVVZl7 ANCHORAGE, AK93510 PHONE (907)272-D218 FAX(807)272`O211 KAS|L0F HILLS, BLOCK 5, LOT 1A MARSHALL 8c ANG|E T0L8ERT 10348 KA3!L0F BLVD ANCHORAGE, AK 99507 ,t- v.^ C1 21.7 26.9 T1 49.438.2 T2 57744.5 L3 / / WT 49.5 39.0 OSP1 11255 Sheet | / / ' 7/'/ LJ zF-� F- -0 / 9 111 o ° SILO FD/P/ / /^ � r // / / SWING �,// B3it CO A8 CL / ' / / / / �o�o r-- / NOTES: RECORD DRAWING LLC P.U.BOX lVVZl7 ANCHORAGE, AK93510 PHONE (907)272-D218 FAX(807)272`O211 KAS|L0F HILLS, BLOCK 5, LOT 1A MARSHALL 8c ANG|E T0L8ERT 10348 KA3!L0F BLVD ANCHORAGE, AK 99507 ,t- v.^ C1 21.7 26.9 T1 49.438.2 T2 57744.5 L3 58.245.9 / WT 49.5 39.0 �1/20/12 Scale PERMIT CE 8149 NO OSP1 11255 Sheet On -Site Wastewater Disposal System Permit Parmi+ Numhar• OSP111255 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 /C- lI - /( (a ll.'a;3 Tax Code Number: 01513327000 Work Type: Septic Upgrade Permit Effective Dates: September 22, 2011 to September 21, 2012 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: KASILOF HILLS Site Legal Address: KASILOF HILLS BILK 5 LT 1A G:2541 Owner/Address: TOLBERT MARSHALL E 10340 KASILOF BLVD ANCHORAGE AK 995076427 Site Mailing Address: 10340 KASILOF BLVD, Anchorage Lot Size in Sq Ft: 111317 Total Bedrooms: Y This permit is for the construction of: 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. Special Provisions: Prior to construction: The number of bedrooms the septic system is serving shall be determined. The septic system is approved for three (3) bedrooms and shall be upgraded using a change order to this permit for four (4) or more total bedrooms. Special Provisions: Electrical: The alarm system shall be on a separate electrical circuit from the pump controls. Jb/12//! �eld oveifjuili COnsficAc+.'on, ,4dr$uw4"e_ f"vr y br, 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 Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 61!5= 133-Z7 Property owner(s) �lA�_p� 4A16 -IE %n! BART Day phone Mailing address [03c/n, A94jetF t �/ct�o�cAlrE LJX 149-67 Site address 1a34o "near GLy® Legal description (Sub'd., Block & Lot) Klalar Legal description (Township, Range & Section) Lot Size 111, 3rz Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Initial ElAbsorption Field ❑ Septic Tank Upgrade Ez Holding Tank ❑ Renewal ❑ 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 Fphnily Dwelling and is in accordance with applicable Municipal Codes. or Permit/Rush Fees: 1)C70— /Lo oatLW&4Waiver Fees:_ Date of Payment: Date of Payment: Receipt Number: C3 3alo y Receipt Number:. Permit No. CyS 10 t �i d J` S Waiver No. GABuilding\On Site\Forms\Client FormsTermit App_010411.doc (Rev. 1 A 1) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panensak.com September 15, 2011 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: Kasilof Hills, Block 5, Lot I Emergency Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1500 gallon S.T.E.P. tank be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a three-bedroom house and will be verified to determine that it is operating adequately for three bedrooms during installation. The condition of the existing steel 1000 gallon tank is unknown and the 300 gallon lift station has deteriorated to the point that it is not repairable. The damaged lift station is exposing the raw sewage to the environment. The existing tank and lift station will be filled with clean gravel or concrete and abandoned per code. The surrounding lots are served by public water, and there are no wells within 100 feet of the proposed septic tank. This lot is served by a private well that is over 100 feet from the existing drain field and proposed tank. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 2 slopes from southeast to nowthwest at approximately 15% in the area of the tank replacement. The proposed installation will be located in the central portion of the lot next to the existing septic tank and absorption system. s aihng� PD. Box 1.00217, Anchorage, Al( 99510 0211.7 Physical, 611.5 East 2— Ave, Cuite 6,Anchorage, AK 9°^�i50 3 Telephone: (907) 272-8218 FAX: (907) 272-8211. Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: allln: P.O. Box .1.0021.7, Anchorage,. AK 9951.0-021.7 Physical: 615 East 82"' Ave, CWte B6, Anchorage, AES 9950 Telephone: (907) 272-8218 FAX: (907) 27.2-821.1 /1A / / `s WELL (E) EXISTING COMPROMISED 1000g SEPTIC TANK AND 3008 LIFT STATION ABANDON PER CODE / 1 101.8 INSTALL 15008 S.T. E.P. TANK (P) W/ DCO BEFORE CONNECT TO DRAIN FIELD (E) 101. DRAIN FIELD (E) TO BE VERIFIED SEPTIC AREA (E)DURING INSTALLATION M / OF S.T.E.P. TANK 2A \ :�F WELL (E) � 3�1 I o Z fr � U � 3 KASILOF BLVD NOTES: PAMOM ENG SVC, LLC EMERGENCY TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 KASILOF HILLS, BLOCK 5, LOT 1A MARSHALL & ANGIE TOLBERT 10340 KASILOF BLVD PLAN ANCHORAGE, AK 99507 OF 3BR HOUSE (E) D/W Steven �f2. �F'annorie� CE 8149 ikv, -' PR6�fs'sioNP� w w J W r an Date 9/15/11 Scale 1"--50' P.I.D. NO 015-133-27 PERMIT NO. xxxxxxxxx Sheet 1 OF 1 MUNICIPALITY OF ANCHORAGE Q 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 _ `'\'1 We ^� PHONE� y NFW 2..� cI 1 �Z ❑UPGRADE MAILING ADDRESS 3330 Mt Vey-non Ct q q 5-0,5 LEGAL DESCRIPTION Kws I. 4 1)S $ K t-o't iA LOCATION NO. OF BEDROOMS 3 DISTANCE Well Absorption ares Dwelling PERMIT NO. —(}T�. TO: I­_ Z Manufacturer % Materials. No. of compartments LU 2. Liq. capacity in gallons I o 0 F HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling s PERMIT NO. 0z U z Q X Manufacturer Material Liquid capacity in gallons ❑ w DISTANCE TO: Well I ®� Foundation hu+ h Nearest lot line E d , PERMIT NO. (_© i— 7 a z LU No. of lines Length of eachlineTotal length Qf li�7es Trench width _ _ Distance between lines f 7 l — ._--.— � _J , '3 CD Inches Top rile to finish —_ Material beneath N of grade rile qc `6 Total of absorr[�ti n area 'foo ® inches {ip Length _� Width Depth PERMIT NO. w 0 a F- Type of crib Crib diameter Crib depth -total effective absorption area wa N DISTANCE TO: Well _ Building foundation Nearest lot line _ w � Class DISTANCE TO: Depth Building foundation Driller Sewer line Distance to lot line PERMIT NO. Septic tank Absorption area(s) OTHER PIPE MATERIALS P ('1LJ+i-r_ .�•' L, SOIL TEST RAT[ NG Ci 1 INSTALLER ATC �yl�=r r X52 5 REMARKS ^T APPROVED DATE LEGAL 1-3- eZ. KeLs;I ���1 R-.-- JL �-' " L_ Xn� k__l I- " FA k~" k-1 t�' 1-1 k_3 P-_ DEPARTMENT Or HEALTH AND ENVIRONMENTAL nnOTECTION ' 825 /L STREET, ANCHORAGE.- HK. 9S, 1 264-4720 0 N— :F. I~F FF F= W FEE FZ F- E- Fe Jr -1 I-� PERMIT NO. ( 82078] ) APPLICANT DONALD J MILLER 3330 MT VERNON CT 99503 279-4720 LOCATION LEGAL L1A B5 KHS%LQF HILLS S/D LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/8R)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �RD- �����F-A- ;2_2 ��"%-*F=L_ ���-FkA NE -- THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF R 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). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY HN[) THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -T- 114 f --p ��::, I IN:F; F=E--- C_- -IF I Cl NS=_. " FR' E: ������I-= LD, BACKFILLING OF ANY SYSTEM 141THOUT 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 H PUBLIC WELL DEPENDING' UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LIME IS 25 FEET AND TO 8 COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ����1-T" E:>�Fftl.FZE:_�=_ 0E:C:_E:r-lE�UFl., �:JL, �S_l �-:);2 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 THE CODES. 3: I UNDERSTAND THAT THE 8N -SITE SEWER SYSTEM MAY REf]UIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED: ~--___-__----------------_-~~_~___----_-- APPLICANT DONALD J MILLER ISSUED BY�. ----------------- '-~-'' D8A���......� (-/' 1K__ 025 'L' STREET) f1W,4J9AOFs € K 995131 264-47-2-10 FiFpl_, o:fl J T C ONOLf J PULLER SRT vMNION Cr 99503 z79"4f :�,'g ; U lA B5 KRS I LOF HELU ID LOT T � 1 ZE 999999 moiAIURRE Ff TF r°AXIAX M NUMBER CV- ;OR011W 3 OIL, R# rma (SQ. FT/OR)s; 05 THE LENGTH Dtr-FJ5IOlq IS THE LEWTH Gftq FEET`) 13F THE TRENCH CIR ORRIWEJELOO THE i f'UJ OF F# TRENCH OR PIT IS THE DIST8N.'EE HET14REN THE 5URFMC Or Tw GROUND 040 THE. BUTDIN OF .THE f14 FEET).. THCRr r9 NO SET WIDTH FOR TREP0,-HE';. THE ORMML O ITH IS THE mINIPAit9 0CPTH JrGaRAVEL OETWEEN THE fjUTFi A_ PIPE. P-ER141T- i' '€$LTiCRNT HWa THE RTZSP WSIGIL.tTY ro Its OR14 THIS t,zEPHRTh' NT DURINU THE( INS_-TALI-HTION INSPECTLOf`1S_ O ANY WCU,13 8DJW-ENT TO THI'5 R'ggMRV-e ANO TK - - wmiaER OF RF-As;tt NCCS rHRT TW--W'-:;U- WILD '.�CAYC - ,.n__......_ OF ANY SYSTEM WITHOUT FINRL INSVECfION MID APPROVF4- H`c, T"rs DEF'MT'T'fw wiL L or zusiFeir TO PRCtWXJJTf0k t £#ixf'izt� DIaTHi°ICE 8CTl,4ECN A 140,L i=lWj RNV f---warA or-5flosilL 5,11 rem I € 13R €9 €'RIVAT9 WIPU. OR 150 TO �t�f3 FEET tYR+JI9 ft Q!=M ItF i',10Li UPON Tw, TYPE far P J#3LFC WELT rrNrIjull uLsrrjf FRO" A PRf5 gyE TPLL ro n F'F2i n,w B IER TRttlE, 15 2,a r -w -T' IINVD ro in commuNr iv !W,!•3F_ P LINE IS ?S FEET, o rHp—f€ RFimuLkEtwars may APPLY. aFEI;LE'rt:,iiTrmrs € riD coj*smucT om omekom, Fes; F7�1rg ri/ i cy TO YNSU F --PROPER fNSr U4TasX0N. �$ y CERTIFY THAT :T..: i AM FANT.l, RR WITH THE REQUIPE NN i'QP OH-11TE E �30'W.Rls AND WMU AS SET FORTH BY TW- Fil. Nr IPPL.iT'Y OF R Hi7RAOG IN FICCOROAIXG 141T14 14 TK :s. I I UNOERSrAND iHAr TK' M -'SITE MIAER V-STCH MAY REQUIRE R4UlRGVECNr V MC, 1 zs If JC I1 /RE#'']ODELEfir/ TO INCLUDE t°iOPC THRrtf € 2DROo-0 . HpJL i cpm i 60KO O J 0 I LLER R �v°3.± �j�' Y...tny_�1. I,NcSlIxw.q 4 J w¢eo ur4s .ae i NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION �GREA R ANCHORAGE AREA BOF IGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 �l /l !� J '//i U `!_p ' TELEPHONE 274-4561 �-r, � ���2_,_ vv o/v Ll! slpw*ac-lDI9r-c3 l SfSIEW— APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED I MAILING ADDRESS FIELD OTHER TO BE INSTALLED BY�^=- ! Lice NOTEI THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL DRAIN FIELD SEEPAGE AREA SIZE SEPTIC TANK SEEPAGE PIT , DRAIN FIELD TO NEAREST LOT LINE A� WELL TO SEPTIC TANK � �"- SEEPAGE PIT DRAIN FIELD —, ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK — SEEPAGE PIT DRAIN FIELD SEPTIC TANK, SEEPAGE PIT . DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM I'D BOROUGH REGULATIONS REGARDING INSTALLATION. G A.A.B. OR UCENSED DESIGNER TYPE DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHOR , DESCRIBED SYSTE i IN ACCORDANCE WITH SAID CODE. DATE [[[ APPLICANT'S SIGNATURE FORM NO. EQ -016 REA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE � I ✓ - _. - - - -- - - -- -- - - 1 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHOR , DESCRIBED SYSTE i IN ACCORDANCE WITH SAID CODE. DATE [[[ APPLICANT'S SIGNATURE FORM NO. EQ -016 REA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE �T.►it g�1DLZ'>f•: IEO. ,'l�:�CII01(iAC31E IELL'DRILLCD AND CASED OUT•T0-7HMDEtPTH-C 0 ­2LF2 FOOL,..{;",, ,..r_[c,t _�."__•,w.n,.f 'Iyf.:.�'...►`'..�9:'pC�jjZt.t• ::-SITF_�g1I ,.,1: .. .,:..' � I:r,.:n.i.[y..': ?':q -j, t:.y,<3.��,,�•��•�,^:ay f• .L S1L?�_oF2,Pl-� ?h•111L�*.Q•Wos I .. t•.;.: ..,r.:.rr•f;',f,')'�i�: , .. �. 'G •-.'.. ':yi tj:4{;:.a nj.l r. :�. :. �1.*t(Si _.Ji.C.t}. tIPlT11 '65111 }1Qt11r+'eTl�•� I. y'"'i=•, {,.,.� y{i�:,�!'r !$fd15d•1LATf •'CrLE� bard i.Tit.O �tdt•CCiC It40 j1:1..•.t.. •.:e, "of vater I Frodcoing'.1"1•%2'GPzt ....: '. �.. .-' • 1,1..-.. '177 �';�r. �.1�• :_.'jtll'�l l..• •^11,1 ,.•i..�, :,��r, �;T.: t�L: •• •,__ _I •a w_ nri:.'14.'• Ir+•S 7, Y. y`j: •'•1. S"OCkYtt}4'"^Y r: 7:1 �C�- ••,�a_�'j+..:••'1�. ?1•, :1.1.,_yj•i.l,). y7.: �l iysy' ms`to.havo•Ai: very f"t reomrys� �leo.ehoulrl in eaaa;iri y_�ld'w ld'.be `Sn6ta71ed tiw'fjet off. bottoe. '%'r :y •i� i" ,(^+ >dDFa�'^2G.ftet �Of•Aa^fACO�.. �. �._!,. •• •••',�.'.•:ai��r '1. .i yii:, ;. l'.,.�„ LEdi' ��'' ^�..i: .; -I �;J, �.`.•;.. .ti'''p.•.. r, 1i.,�,IJ....ty .�,.•�, ,' ❑;I,',`.' .•. ;.5\a . r..q. ,'1: r �{fin,.. •: �. Ij AJ i, ���•.'r'4���•�r, 17 ALL' LADOR'AND'MATERIAL-FOR.COMPLCTION OF �AlI3 �RILLING,'", Y' • . • .. . •x"975:CO ADLE TO RAMPART DRILLING,WORKS FOR.THE EUhi bF-- fOU VERY MUCH.. " ,1-1+ '.. .••'_1,'�:',�:. •.'!'.?j.. pry ..i �f'1; 'l�:•.�. 1, jk •DER CLAUS OFRANIPART D ILLIfNG .WOR r :HAnCr0V i -,,.n PER MCHTr{ WILL DC A7C ESSCD .ON,P UEACC9VNl9d 4, ':.h •: r4 •.'� '.arra O TH-1 No scale TH-1 NO WATER TABLE Log represents location of Test Hole Lot 1A, Block 5 Kisloff Hills Subdivision Consultants Inc. L ANCHORAGE FAIR ®AMK9 ALASKA JUNEAU DATE 9-30-75 SCALE 111 31 OWN SY WED CNKD 8Y WED 1.5' ;W) 14.0' T.D. DON MILLER PROPERTY Log of Test Hole Anchorage, Alaska PROD. NO. 562131 DW6 NO. A-01 Js ANCHORAGE nINN➢ CO:ti7liC,TA:�Tti, INC- JUNEAU 249 EAST 51ST AVENUE ' P.O. BOX 6007 ANCHORAGE, ALASKA 99503 TELEPHONE 907-279.0483 TELEX 090.35419 September 30, 1975 Mr. Don Miller 310 West 32nd Avenue, Apt. 12 Anchorage, Alaska 99501 R & M No. 562131 RE: Test Hole and Soil Log Report for Sanitary System Lot 1A, Block 5, 3 sHi11s Subdivision e4S/Lo-F Dear Mr. Miller: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This inves- tigation was performed in accordance with your request of September 29, 1975, and those procedures outlined in a letter dated July 15, 1975, by. Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot lA area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with an auger type drilling rig and the test hole was extended to a total depth of 14.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. 9fm7esW. Rooney Vice President JWR/WED/ja Encl. xc: GAAB Municipality of Anchorageo On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-133-27 Expiration Date: 1. GENERAL INFORMATION Complete legal description KASILOF HILLS BLOCK 5, LOT 1A Location (site address) 10340 KASILOF BOULEVARD, ANCHORAGE, AK, 99516 Current Property owner(s) MARSHALL & ANGIE TOLBERT Day phone 341-9042 Mailing address 10340 KASILOF BOULEVARD, ANCHORAGE, AK, 99516 Real Estate Agent BETHANY WEISER W/ JACK WHITE Day phone 762-3111 2. TYPE OF DWELLING: e Single Family (w/wo ADU) ❑ Duplex ,❑ Multiple Dwellings (Single Family and/or Duple> ntr 9 3. NUMBER OF BEDROOMS: 4 SEP 3 € 701 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ COSA Fee $ 54 -7 / Date of Payment � 1 3,1, g ch,_ Receipt Number Ok G COSA # (SSU 4 Waiver Fee $ _ Date of Paymen Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 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 Address GARNESS ENGINEERING GROUP, Ltd. 3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, AK, 99507 Engineer's Printed Name Engineers Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LfD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions am outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefrf of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved. Conditional approval for 0 bedrooms bedrooms, Phone 337-6179 Date id 36/1if- �OFESSt��i V�,�'`2-i1OFtAA/c, rix, r QQy'Pym �= ON-SITE with the following stipulations: WAT cR gTDR o O IJV \Z t Original Certificate Date: Z D - 6 - The Municipalityorkrchorage Develop,emt 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 engineerregistered 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 Septic System Advisory Well Flow Advisory me.,� innvi?i Nitrate Advisory Arsenic Advisory Other If more than t septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA Well type PRIVATE Date completed 11/13/1975 Total depth 175 ft. Date of test Static water level Well production KASILOF HILLS SID; BLOCK 5, LOT 1A If A, B, or C provide PWSID# N/A Sanitary seal (YIN) YES Cased to 40 ft. FROM WELL LOG 11/13/1975 WATER SAMPLE RESULTS: 20 4 9 - p.m - Coliform 0 colonies/100 ml. Nitrate 1.42 mg./L. Arsenic: ND ug./L. Date of sample: 8/28/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P.ISTEEL Tank size 1500 gal. Number of Compartments 2 Foundation cleanout (YIN) YES Depression over tank (YIN) NO Date of pumping 8/2712014 C. ABSORPTION FIELD DATA Pumper. Parcel ID: 015-133-27 Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 8/28/2014 - 22 ft. 3.18+ _g - p.m - Collected by: GEG, Ltd. Date installed Cleanouts(Y/N) _ High water alarm A+ HOME SERVICES 1 011 112 01 1 YES YES Date installed 9/3/1982 Soil rating (g.p.d./ft or /bdrm 85 System type TRENCH Length 25 ft. Width 2.5 ft. Gravel below pipe 8 ft. Total depth "11.3 ft. Eff. absorption area 400 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/28/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test "<32 in. Water added 605 gal. New depth84 in. Elapsed Time: 120 min. Final fluid depth 55 in. Absorption rate >= 600+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date NOTE: SUMP ONLY EXTENDS 64" INTO 96" EFFECTIVE DEPTH. TOTAL DEPTH AND LIQUID LEVELS ARE THE CALCULATED ABSOLUTE LEVELS BASED UPON THE INVERT OF THE DRAINPIPE AS THE VERTICAL DATUM. "SUMP WAS DRY AT BEGINNING OF TEST. LAST 490 GALLONS INTRODUCED RESULTED IN 28" CHANGE IN LIQUID LEVEL. DRAINFIELD ABSORBED AT LEAST 150 GALLONS IN 120 MINUTE RECOVERY PERIOD. *IT IS ASSUMED THAT STEVE PANONE, P.E. DOCUMENTED THE INSTALLATION OF A 1500 GALLON TANK. D. LIFT STATION "CONFIRMED BY ACTIVATING FLOAT WITH HOOK BRIEFLY. TANK WAS EMPTY AT TIME OF TEST. Date installed 10/11/2011 Size in gallons *1500 Manhole/Access (Y/N) YES "Pump on" level at -40 in. "Pump off" level at -36 in. High water alarm level at 45 in. Datum BOTTOM OF BASKET Cycles tested '*1 Meets alarm & circuit requirements? YES 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 N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 5'+ Absorption field 51+ Water main N/A Water service line 10'+ Surface water 1004 Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage UNKNOWN Curtain drain NONE KNOWN Wells on adjacent lots 1004 F. COMMENTS NOTE: PRENK CLEANOUT COULD NOT BE LOCATED DURING INSPECTION. FCO IS SUFFI-TACIENT FOR CLEANOUT ACCESS BETWEEN HOUSE AND TANK. *NOTE: DRAINFIELD PIPES COULD NOT BE LOCATED FOR PROSPECT HTS #4 B2, LOT 7. 100' SEPARATION IS ASSUMED BASED UPON CONFIGURATION OF WELL ON PROPERTY AND PREVIOUS ENGINEERS DOCUMENTATION. WELL ON SUBJECT LOT PRECEDES THE SEPTIC INSTALLATION ON PROSPECT HEIGHTS #4 BLOCK 2, LOT 7. SEE ATTACHED INSPECTION REPORT AND DRAWING. .��aaaaa��t G. ENGINEER'S CERTIFICATION ��P�E.OF/1/����♦ 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. Engineer's Print)d Name JEFFREY A. GARNESS Date �� 36//+f (Rev. 10112/12) umv/.%11&6� 4 iQ ♦ ��'i� .ROF SSION ���•i .A Lot 86 p/ / Lot 7 i R G Q1 WO Lot 2A Note: Shared Driveway & Shed Agreement exist. Op oCb Lot 9 LOT 1A GO. s eAf/c Shed (91)r. X:�. 00 L Kz Kasil �?2g 4 `q 9 30 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. I ADC Fb06-5, pg. 43-44 ti rn 06 0 L0 0 0 0 VA 24.4 41.7 Lot 6 Lot 7 Lot 8 Lid 3 Chimney OH HOUSE DETAIL scar F 7,I -am 8302P SCALE: 1"= 60' U) O ��%N"` X OF r �. 49th I� .00 00 4 ,•.Fred Wal atka; ff j ss 3255 - S I OFESSIONA� �N REVISED 9-18-14, 9-29-14 fJ' X RECERTIFIED 9-14-14 AS -BUILT NO CORNERS SET THIS DATE /1 /I \ / I \ / I / I / I / / I I / I / I / I / I / I I I I I I I I. I I I' LOT 1A GO. s eAf/c Shed (91)r. X:�. 00 L Kz Kasil �?2g 4 `q 9 30 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. I ADC Fb06-5, pg. 43-44 ti rn 06 0 L0 0 0 0 VA 24.4 41.7 Lot 6 Lot 7 Lot 8 Lid 3 Chimney OH HOUSE DETAIL scar F 7,I -am 8302P SCALE: 1"= 60' U) O ��%N"` X OF r �. 49th I� .00 00 4 ,•.Fred Wal atka; ff j ss 3255 - S I OFESSIONA� �N REVISED 9-18-14, 9-29-14 fJ' X RECERTIFIED 9-14-14 AS -BUILT NO CORNERS SET THIS DATE -- .• •..�I yr t n Himu 1-lurvi Stli E5 Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name i DISTANCES EV1 � 6Q- Address _ / TO SEPTIC ABSORPTION �0­r Lf L 1-s 41,/610 FROM TANK FIELD A Phone(sl Permit No. No. 1 Bedrooms WELL a�& LEGAL DESCRIPTION LOT LINE -�- �o' 4151 Il `7 black ^ Subdivision !7rQ5 J, A + All r[ �' L IL /({FOUNCATIUN �4(b •1 1 11 Township. Range, Section' ' T�aN R3 ; t/ &L 13 AS -BUILT DIAGRAM (Show location of well, septic system, property tines. 4 driveway water bodies, etc.) TANKS m—j— L�SEPTIC O HOLDING Manulacwrer capacity in gauons a. rnA L Ad, , n r7<7) Jl w) INO. o(COmpartment� l� ill TYPE OF SYSTEM IIF ❑ TRENCH [T' EED (] W. DRAIN []OTHER gepth io pipe b.dom rnginal grade irom ,y' Total depth from original grade _. FT �• S FT 1 °ill added above original grade Gravel depth beneath pipe FT Q. S FT 3ravel ienglh Grava7 worn blal 2f'Sorph On ar¢a Distance between lines _"—__ sp FT FT lumber of lines 3 Soil rating pipe material _ So FT P /kSTM 30� suer f7 Y� r�"VIS Date InstJa�l lod l�1klXArrINL% WELLS ❑ PRIVATE 11OTHER (Identitvt lass bcafion (AB,CI Total Di Cased to FT FT sialic' Date Installed: IEMARKS: LAI Inspections Perf(a ed by: Dale: sanity that this inspection was performed according to alf Municipal and Stale gVidellins in ¢(test on this date: I t Z� � G Z25 Health Department Approval: F""'"�J�""�^ �- �'•-•–� Date: /—,I (9 WELL y9 M wtiti �ZV °itiN 48378 F g8, O'V DO o i i CP � D f c i �N60'aP15'W ----------------�--------_____ =sr�t \ —N00°00'34°W 9 s m O r L__ to C) N ? O _ V CI1 V kv�O eo c'OS�o <83-2- - -- - - - - - T X O u m O m m_ S cn H\NAv CR 041J Municipality of Anchorage Development Services Department e Building Safety Division ti iOnsite Water and Wastewater Program " 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Ren ewol ot= Parcel I.D. DIS- 133 -2-7 COSA# If AA OS 03 y46'- Expiration 6Expiration Date: 9 - .?-_ O - O (o 1. GENERAL INFORMATION Complete legal description L -o t I A. C3lac k S. krc r, to F if ;11t S ID Location (site address) to 3 vo Prc-xtfof 431&.0( Current Property owners) _IFI -/m riiIle, Day phone 3'!6- 333 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address lo3vo 6coxtoF cIvoe Arck A -k 99Sp7 Day phone Marx S1vwi1rr Pr'uori, kic"/ Day phone 7'18 -SS 79 360) CeI40--noi'of Or-. AncAo�4. /i -k 994-03 ❑ Community Class Well ❑ Community On-site ❑ Unless otherwise requested, COSA will be held by DSD for pickup. Pl m, - ckrt 11 fla,S i-[-cnr 2. NUMBER OF BEDROOMS: 3 7't8-St79 uVAtA COSH rtady 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work. 4. 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 Onsite 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 17& F/oa 7e_cAn rra / Ser&;r v Phone 3 `/s - P 3 s-<- Address I`f33o Ectio COnyoe t1w(. 99S -I1 Engineer's Printed Name _lMro !:A,, -e F. /•+o Ore Date %%uAP hi evoer Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By. a42y _ / W �o Original Certificate Date: (Rw.11105) :=•a+t1t? tale-�. V �� •• 5. DSD SI NATURE ...... Approved for bedrooms. Disapproved. �: • .,�„ ..� v Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By. a42y _ / W �o Original Certificate Date: (Rw.11105) Municipality of Anchorage Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsde (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lo I A., Bloc 4 S'. kws to F /f1761 f / D Parcel ID: O IS' —I A. WELL DATA Well type P✓ f If A, B, or C provide PWSID # Date completedIt /r3/7t Sanitary seal (YIN) Y Total depth Ift. Cased to Ho ft. FROM WELL LOG Date of test it /13/ 7r Static water level 20 ft. Well production •/ g.p.m. WATER SAMPLE RESULTS: Coliform _Q_colonies/100 mL Nitrate 3• y/ mg/L Arsenic: < S ppb dale of sample: 6/'1 Z rfn6 B. SEPTIC/HOLDING TANK DATA Tank Type/Material eA W c Tank size 1000 gal. Number of Compartments Well Log (YIN) `f Wires properly protected (YIN) `r Casing height (above ground) zY in. AT INSPECTION 7/6/0 22 ft. y t g.p.m. Other bacteria _colonies/100 mL Collected by: !c/a f Tec% S'4.c Date installed 9/3 /8 Z Cleanouts (YIN) `r Foundation cleanout (YIN) V Depression over tank (YIN)I* High water alarm (YIN) N. A. Dale of pumping -7/13/401' Pumper A t C. ABSORPTION FIELD DATA Date installed 9/S/ 8 2 Soil rating (g.p.d./ft2 or ft'/bdrm) su- VZ System type TiresA Length ZS ft. Width LS ft. Gravel below pipe 8 ft. Total depth I& ft. Elf. absorption area'AL&V ft= Monitoring tube 4' Depression over field N Date of adequacy test 7 /d!/ os Results (Pass/Fail) roc For 3 bedrooms Fluid depth in absorption field before test V in. Water added 763 gal. New depthIS-4 in. Elapsed Time: 0.7 min. Final fluid depth L7 in. Absorption rate >= •/SG g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Ne Ae know, If yes, give date M. 4 D. LIFT STATION Date installed 9 /3 / 8 •Z 'Pump on' level at IU in. Size in gallons 3dU •Pump off" level at 7•.0 in. Manhole/Access (YIN) High water alarm level at Z 2 in. Datum 1730 Mv— Cycles tested fU 4• Meets alarm & circuit requirements? IJo 000 — E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot go, Absorption field on lot 101 Public sewer main AI -A. Sewer /septic service line > 2S' Animal containment areas Nage On adjacent lots > 1 &0 ' On adjacent lots > 1oc • Public sewer manhole/cleanout N• �, Holding tank N• A. Manure/animal excrete storage areas 1✓a. t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Zr Property line So Absorption field SO r Water main !✓• A. Water service line > /o Surface water > 1C�o Wells on adjacent lots > IUrs • SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 60 Building foundation 1S- ' Water main P. A. Water Service line > 10' Surface water > 100' Driveway, parking/vehicle storage Curtain drain Non[ SIO,^ Wells on adjacent lots �c4V ' F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name r• 1"roo-C Date—d/4 /Od COSA Fee Date of Payment Receipt Number (Rev. 11105) Waiver Fee $ Dale of Payment Receipt Number .. . trtpb OF: g L`CVCF �• *::'CL - 58? SCS ReEN 1062561001 All DatesMmes are Alaska Standard Time Client Name Flattop Technical Srv. Printed Dateflime 06/062006 15.19 Project Name/N Lot IA Block 5 Kasilof Hills Collected DatefTime 05222006 16:15 Client Sample ID Lot IA Block 5 Kasilof [fills Received DatelTime 05222006 16:52 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: SM 2540 C - The TDS result confirmed out of hold time. Allowable Prep Analysis Parameter Results PQL Units Method ContamerlD Limits Date Date Init Nitrite -N ND 0.100 mg/L EPA 353.2 B 0522/0!4 ALR Nitrate -N 3.41 0.100 mg/L EPA 353.2 B 0522/00 ALR Metals Department I lardness as CaCO3 5.23 5.00 mg/L SN120 2340B C 0523/06 0524/06 Nil l Private Individual Analysis Aluminum ND 20.0 ug/L EP2o0.8 C 0523/06 0524/004 Mil Antimony ND 1.00 ug/L EP200.8 C (<=6) 0523/06 0524,'O6 hill Arsenic ND 5.00 ug/L EP200.8 C (<=10) 0523106 05241004 hill Barium ND 3.00 ug/L EP200.8 C (<=2000) 0523/06 0524/06 hill Cadmium ND 0.500 ug/L EP200.8 C (<=5) 0523/06 0524'00 MI Calcium 1550 Soo ugtL EP200.8 C 0523/06 0524'06 hill Chromium ND 1.00 ug/L EP200.8 C (<=100) 0523/06 06/02106 SCL Copper 598 1.00 uglL EP200.8 C (<=1300) 0523/06 0524100 hill Iron ND 250 ug/L EP200.8 C (<=300) 0523/06 0524106 hill Lead 106 • 0.200 ug/L EP200.8 C (<=15) 0523/06 0524/06 hill Magnesium 330 50.0 ug/L EP200.8 C 0523/06 0524/06 hill Manganese ND 1.00 ug/L EP200.8 C (<=50) 0523/06 0524106 hill Phosphorus ND 200 ug/L EP200.8 C 0523/06 0524106 hill Fluoride ND 0.100 mg/L EPA 300.0 B (<=2) 0525/06 0525/00 JFM Chloride 7.67 0.100 mg/L EPA 300.0 D (< 250) 0525/06 0525106 JEM Selenium ND 5.00 ug(L EP200.8 C (<=50) 0523/06 0524106 Mil Sodium 604 500 ug/L EP200.8 C (<-250000) 0523/06 0524106 hill Silicon 4900 200 ug/L EP200.8 C 0523/06 0524/004 hill Silver ND 1.00 ug/L EP200.8 C (ti 100) 0523/06 0524/004 Mil Thallium ND 1.00 ug/L EP200.8 C (r--2) 0523/06 0524/06 hill Sulfate 21.0 0.100 mg/L EPA 300.0 B (<=250) 0525/06 0525/06 JEM Zinc 17.5 5.00 ug/L EP200.8 C (<=5000) 0523/06 0524/06 MII SCS Ref.N 1062561001 Client Name Flattop Technical Srv. Project Name/N Lot IA Block 5 Kasilof Hills Client Sample ID Lot IA Block 5 Kasilof Hills Matrix Drinking Water All Dattafflmes are Alaska Standard Time Printed Date/Time 06/06/2006 15:19 Collected Date/time 0522/2006 16:15 Received Dateffime 05222006 16:52 Technical Director Stephen C. Ede Allowable Prep Analysis Pammeter Results PQL Unita Method Container ID Limits Date Date Int Private Individual Analysis 05261011 KP C (<=100) 0523/06 0524/00 Total Dissolved Solids 308 10.0 mg/L SM20 2540C Nickel ND 2.00 u8/L EP200.8 I ICO3 Alkalinity 152 20.0 m8/L SM20 23208 CO3 Alkalinity ND 20.0 mgfL SM20 2320B 011 Alkalinity ND 20.0 mg(L SN1202320B Conductivity 450 1.00 umhos/cm SM202510B pit 7.73 0.100 pl l units EPA 150.1 Alkalinity 152 20.0 m8/L SM202320B TotalColifurm 0 coVI00mL SM20 9222B D (<=500) 05261011 KP C (<=100) 0523/06 0524/00 hill D 0523/00 PLW D 0523/001 PLW D 0523/001 PLW D 0523/06 CRY D (6.5.8.5) 0523/06 CRY D 0523/00 PLW A (<=1) 0522/06 TLF �e.J Municipality of Anchorage Development Services Department Building Safety Division �. On -Site Water and Wastewater Program 4700 South Bragaw St. s P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o t s - 133 - 2 7 HAA # 3 Expiration Date: /o125"10-r- 1. 2S'1°y 1. GENERAL INFORMATION Complete legal description L't. IA. Black S, icorrloF 14/111 Sim Location (site address or directions) 1 a 3 y.0 ko„1of B 14'ot Current Property owner(s) E t/a Mtfle Day phone 1146' 3?j2 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address I03Y0 /^aj.2oiC ti/..e fin A-4: 995 7 Day phone 1=9 1411 Day phone Unless otherwise requested, HAA will be held by DSD for pickup. P/eaie tat/ Efi+a r'rilltr� sY6�38S2 JAJAen Ii?R V /Iain Fc r �irc4ci� 2. NUMBER OF BEDROOMS:_ 3. TYPE OF WATER SUPPLY: Individual Well 12 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site — ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority 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. Luerr we o- r p is eik e+ffack eeX NameofFirm FyafA_1, iictin!,-«/ Ser..;ee. Phone 3yS-l�s'S Address INt3y C—c-4v /M� ; P /)-- 9Qsie Engineer's Printed Name P• Date Tu /y Z'5 Zc P'S �4-.9TN '.0 .... 000,94 ... 5. DSD SIGNATURE :j T Approved for 3 bedrooms. T1h.-ODCF,. F. MOOR£ <.`� '.� CF -3589 Disapproved. Conditional approval for bedrooms, with the following stipu�ations:�w-�4 Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: " Municipality of Anchorage • Development Services Department ` e� Building Safety DlvWon On-site Water & Wastewater Program ' • "' 4700 South Bragaw, St P.O. Box 196650 Anchorage, AK 99519-6650 www.a.anchorage.ek.us (907) 343-79W HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:A- l- 1.4. 8/&c /e S haw do,4 *,/hr S IP Parcel ID: 011-122 -2>, A. WELL DATA Well type __L&* t If A, B. or C provide PWSID # Datecompleted Il/13/-ys- Sanitary seal (YIN) -X- Total Total depth 1_J�L_ft. Cased to _P—fL FROM WELL LOG Date of test 11 / 13 / '7t Static water level 20 R Well production Y g.p m. WATER SAMPLE RESULTS: Coliform _Q_colonies/100ml. Nitrate 1.9-7 mg.A. Arsenic: = mg.A. Date of sample: 7 !l/ot B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Y Wires properly protected (Y/N) _ Y Casing height (above ground) '_in. AT INSPECTION 2 2 ft. IF* g.p.m. Other bacteria . G colonies1100 ml. Collected by: __ -(a New Tec/, d'�I Tank Type/Material Sar f%c / S /•. e / Date installed 4 /3 /10 Z Tank size I &Cy gal. Number of Compartments Cleanouts (Y/N) i Foundation cleanout (Y/N) _ r Depression over tank (Y/N) _I High water alarm (Y/N) Ar. 4, Date of pumping 7 / r 3 /Os Pumper A t dra,fne C. ABSORPTION FIELD DATA Date installed / / 2 Soil rating (g.p.d.fte or fe/bdrm) _Iftg O t� System type _i ryr cit tw- Length ?e -r ft. Width 2. r ft Gravel below pipe ft. Total depth L_ ft. Eff. absorption area ' L� to Monitoring tube _r Depression over field N Date of adequacy test 7 /:/Z40eJs Results (Pass/Fail) —PeW For 3 bedrooms Fluid depth in absorption field before test 1_ in. Water added 740 gal. New depthAf.� in. Elapsed Time: l27 min. Final fluid depth 27 in. Absorption rate >= YX'G g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NoAa hcnd rrn If yes, give date N. +. D. LIFT STATION Date installed 91316 L Size in gallons 300 Manhole/Access (YIN) Y _ 'Pump on' level at to in. 'Pump ofr level at 7s in. High water alarm level at 2 2 in. Datum Cie i4AP— Cycles tested 10 Meets alarm & Cirarit requirements? No mSt �i�ad E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 90 Absorption field on lot 1 a f Public sewer main N - A. Sewer /septic service line 7 ?.f On adjacent lots > f ua ' On adjacent lots > /UG' Public sewer manhole/cleanout N• A•. Holding tank _N - J. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 2 S Property line J'& Absorption Held Water main 11J. A. Water service line L'i ' Surface wafer' rac,' Wells on adjacent lots > 144:P1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 60 Building foundation /S Water main _ Al. h. Water Service line 1 to' Surface water > AZ#4" ' ' Driveway, parkkq%WWe storage i— to Curtain drain Noes Sirtn Wells on adjacent lob <uo F. COMMENTS L fQF; , G. ENGINEER'S CERTIFICATION PH , ......i 1 car* that I have determined through held inspections and � .....••••• � 4 review a Municipal records that the above systems are in 1; t,J� ......; •... ..:..,.. conformance with MOA HAA guidelines in effect on this date. 1; :rF "..,•. r , uyi fir Engineer's Printed Name 73lteyatorp F: HocP— :; '` , ••,.. �0, ,r� ``ti Date �.I u 2 0 o s^ r' HAA Fee $ ''/30'= Waiver Fee $ No Fs e - Date of Payment _ OJ Data of Payment Receipt Number 4 //W. Receipt Number (Rev. 12/01) •07-19-05;08:33 ; SCS Re" 1054015001 Cheat Name Flattop Technical Srv. ProjectNamdN Kasilof Hills Client SamplcID Lot IA, Block 5,KuilofHills Atatris Drinking Water.. PWSID O Samek Remarks: ;907 561 5301 Alt DatrwTimes are Alaska Standard Time Printed Dstdiime 07/14/2005 13:33 Collected Datdfimt 07/06/2005 12:55 Recei.edDstcMme 07/062005 13:52 - :Teehatcat Director Stephen C Ede 9 2/ 4 Allowahlo Prep Amlysis Parameter Results POL Uniu WOW ContainerlD Limit% Dan Date Init Haters Department Nivam•N 1.93 0.100 my/f. EPA 300.0 B (<-10) 07/07/05 IEM Microbiology Laboratory Total Coliform 0 eoV100mL SM2092220 A (erl) 07/06/05 TLP rtL�Euc o Guo 5/� kE � jF ■ � p uLr 4 V CIrAIC I 'L L- / ' � I y 1 \ to o .J / � I i I 7 J I l 1 E✓l;C_K !i / 1 i �., H4C"'", I. t�SCl--t E�iS ��•,;•.Il..t a2� -f�C� '��N -1 -1,- -! 17 La'S !_.t, i ZA, 1..:!ll_S SCE oISU yr�G,t Pew u. Iro 520+" s, A :Div,w- •+ USi;.a EI'Elili'.11E11 CHKD:..i C�"'i. Eny n.t••= 5„•..•r DATE -5-'1 SCALE: I"=;��' FD Fin. -3107 bmv. 'M % 14 Y V t `�: •••'•• '1 '•'Sid.) � p • ov J li:••1.1 .• )j LS I a GRID' DWG: Municipalii3' Of Anchorage YI , 1'.(>. IAI� 1NA'w+0 • .\nchoml;c, .\Inskn �J!>,il!IGf.X) •Telephone l!>t17) 9i3tf,'701 • 1'ur (!Xl7) 87:4�fS:(MI s • T j 471111 I{mgux• Street • Anchomgc, Aluslm !Y.4i117 Mayor Mark Vegich 13ttilding Safcty Division July 25, 2005 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, AK 99577 Subject: Waiver Request for Kasilof lulls Block 5 Lot lA Waiver Request WR#: 050052 Parcel ID # 015-133-27 IIA050346 Dear Ted Moore, P.E.: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 90.0 feet. The 90' well to septic tank horizontal separation was approved on the permit issued on 8/11/82. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jo oodall Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#:050052 PID#:015-133-27 HA/Permit# HA050346 Dale Received: July 25, 2005 Legal Description: Kasilof Hills Block 5 Lot I Engineer. Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, AK 99577 Applicant: Etta Miller Waiver Requested: 90' well to septic tank horizontal separation waiver Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: Total: .......................................................................... Waiver Is Granted: X Waiver is not Granted: List Conditions or Reasons for above: Date: 7125105 By: Joe Goodall Name of Reviewer Rec#: Amount: $0 Date Paid: 712512005 State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District office Engineers dated January 3, 1935) Waiver Request for hasilof Stills Block 5 Lot IA Parcel I D#: 015-133-27 Waiver Request Number WR#: 050052 Waiver Requested: 90' well to septic tank horizontal separation waiver Engineer. Ted Moore, P.E. IIA050346 Septic Tank Data The septic tank depth according to Flat -top Tech is 9 feet deep. The septic tank and lift station was installed 9/3/82. The permit for this tank installation was issued on 8/11/82. On the permit the Onsite department granted a 85' well to tank separation approval. There were no points calculated however it was granted by the department on 8/11/82. Well Data The well was installed 11/13/75. Flat -top Tech Services did well flow test and took water samples. These results located on Health Authority Number HA050346 Check list. The well encroachment to the septic tank has been in existence for over 20 years and there is no evidence there is a health concern. The water samples showed o coliform, 1.93 mg/i nitrates, 0 mg/I other bacteria. - -_ _- - - _ �,. - v' �� t b � -__ [Tf �� .! ��.�. � R v • �' � L _ �._ t _ '�i � � N V � I __ _ _ ..��♦ ._- _ - n F G J.r �y �� �'1 1 f.. _ M� r _ l C. ••i •_ .�. • f 4 Y . �1 , � {.� _ `wry T'•At' _ � _ f ♦. w � � i � V I I1 t 1. .. - • , '�/ � 1 1l r \1 � ,�`i � ~• yM �)�) lam- ' I .. f , { i (f t i + • kkk , r. t. 1 �,-+..�,,, r e1!r` ,�� �;C. rt•` : ti Y i ' 4.' y '�, o r ' f :'.,� Y _ � ,�.e.' f. _��� r'ti-,: s, , ' s ._ I • ..(s a y �!� , -trr• J ♦� '.tf: �- -.✓ �: ..ri✓.�,. .r rr 1. 'I �. '1 4� "/- ArF- -\�.. rJr .f rrf�-� "` r. J r , r e r !�` � l) _'' ' Al ( . (-`r• a //\T ,�.t � a ^ }1�.�:�. .- � � r r . rY 1-� r r �- Ali fl ` e; I'r it , + y. t♦ f- ♦ 1;, M.i. ., i �, { -r r �. � I -- ft - rl 1 1". (r1 ♦ � a f � yam.. f' ,. a?^JI li.-'� al t 1 ♦. i {I f`{ }♦ ;`r r• .r s•; -.r �" '! J :-it -. •� "-r. ..a �, JYi 1JPiS1 /:r At � «.'iP � a h9 {I�`.�•t1 }� i�i fff i r ' Y aa•.c �'s'.o�rr id4. {I ; �fls; ( irI„\ �/qrp. f�{} � 4 f,.t X19 1 i p .A _ - � � t `r i 1 i� �� � r �I17f r 1 j��Y .17t f rld t•r ltf Iv��i� (\ C.� a•.. 41 r'1' f fr i�Ij'iN ~r •�� t��d tf�rV ,� ♦yf\a� rrl`.y�r�A fitf `t .af ./ �' , r � . /.1 j. : %.y i.•� {r{' / `. r � �� ; '1`<, !/ ��/ /{. �1' \f(' SCJ! ^' l / ! lA ny {', ` ' 1': • r�.rrs s i,.. �Ad��' �i h��.. si'Yr l�J wd�J t� ``•wi ����I��ti�rf/ aer\-��71��.t�I4. IJP:' •F [�.• A/,.r'• 1, i. �'� f<r^ i; y � ,/ �-./17' �,y,Ay.� r: !'� 1 / 1 r ` - f ��"`IG aS ` "`r 1: f ' r r I 1 rr 1'T- t � . f � •y.. ti � r. f. f � !�.'�, � 7l , :') L^/7'.i. r.i v?\+. i'�f1r 0 �'%S,ji S.rriR y/- fit, .:�.. �- .. ai, •.4l �a t¢ :.1.. . -,f f. 0. .FLATTOP TECHNICAL SERVJCES.- CIVIL & ENVIRONMENTAL ENGINEERLVG • ENERGY CONSERVADoN & ANALYSIS TIIEODORF. F. MOORE, P.E. 14530 ECHO ST. Pit: (907) 345.1355 July 19, 2005 ANCHORAGE, ALASKA 99516 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: By means of this letter we are requesting issuance of a formal separation di>tanee waiver approving the location of the septic tank on Lot 1 A, Block 5, Kasilof Hills S/D at a distance of 90 feet from the well on the same lot. In support of this waiver request I am enclosing a site plan showing relevant features, plus the driller's well log, the septic installation inspection report, the septic permit, water sample test results, an as -built survey of the property and an application for a HAA certificate. I understand that because this reduced separation distance was specifically okayed on the septic permit at the time of issuance that Municipal policv is to forego imposition of the waiver processing fee but to require submittal of a formal waiver request. According to the driller's well log, the well was completed in May of 1975 and has a total depth of 175 feet and a yield of 4 gpm. When I most recently tested the system on July 6, 2005 the static water level stood at 22 feet below the top of the casing. Steady pumping of 763 gallons of water from the well at the maximum pump output of 4.2 gpm caused the water level inside the casing to be gradually drawn down to 128 feet. Based on the test data I concluded that the yield of the well is 4+ gpm. Water samples collected on July 6, 2005 were satisfactory, showing 0 coliform or other bacteria per 100 ml., and 1.93 mg/I of nitrate -N. The wastewater disposal system serving this residence was installed in September of 1982 and consists of a 1000 -gallon steel septic tank that discharges effluent into a 300 -gallon lift station tank. From there the effluent is pumped up into a 25 -foot long soil absorption trench with an effective gravel depth of 8 feet. I tested the system on July 6, 2005 by running 763 gallons of water into it through the second compartment of the septic tank from whence it flowed into the lift station and was pumped up into the disposal trench. The initial fluid depth in the trench monitor tube was 21 inches and the maximum depth achieved was 35.6 inches. When I rechecked the fluid depth 127 minutes after the flow of water was stopped it had receded back down to 27 inches, indicating that the system continues to be adequate. At the time the permit was issued in August of 1982 allowing construction of the wastewater disposal system the issuer added a hand-written notation approving a waiver allowing an 85 -foot distance between the well and the septic tank. The purpose of this submittal is to provide retroactive justification for that decision. The topography in the area at issue slopes down towards the northwest at approximately 15%. The ground elevation at the wellhead is higher than at the septic tank, so any surface leakage from the septic tank would tend to flow away from the well. The following is a breakdown of how waiver analysis points could be assigned using DEC's 1985 "Separation Distance Waiver Guidelines for SCRO". Points Category Distance to water table (113' depth to aquifer — 9' tank depth) 7.0 Soil Sorption (predominantly gravel and rock) 1.0 Permeability (predominantly bedrock with pere>50 min/in) 3 Water table gradient (5% slope away from water source) •4.5 2 5 Horizontal separation 90' Total 18.1 Based on this point assignment it appears that the waiver can be safely granted without concern as to potential contamination of the well due to the proximity of the septic tank. The fact that the water sample test results show no coliform or other bacterial contamination after over 20 years of proximity is further evidence that a contamination problem does not exist. The nitrate levels, while somewhat elevated above the minimum detection limit, are typical of this area of the l lillside. Please feel free to give me a call if you have any questions on this submittal. Sincerely, 'r1.,,( 9t'lvo..c— Ted Moore. P.E. cc: Etta Miller, 10340 Kasilof Blvd., Anchorage, AK 99507 SEPTIC TANK UFT ST SEPTIC AREA VS, . B�SEWER GVL. ouE R 100 WELL i LOT 1A, BLOCK 5 . KASILOF HILLS SID WELL —R 100' �R•w._ LOT 2A, BLOCK 5 KASILOF HILLS SID J, \ v Om/ / OF CA49 m iii *1 lo...: � ./.�....��.d.....�............ 0Y..:•T..1:.....:... • TREODOREF.YOORE CE - 3589 .0 �c j LOT 7, BLOCK 2 PROSPECT HTS. #4 (NO SEPTIC WITHIN 100') .I , LOT 8, BLOCK 2, PROSPECT HTS. #4 N i LOT 1A, BLOCK S, KASILOF HILLS SID SEPTIC TANK WAIVER SITE PLAN T FLATTOP TECHNICAL SERVICES 11INCH=100FEET DRAWN BY TFlA 14330EC110 STRCET JULY,2005 ANCIIORAGE, ALASKA 99316_ NOTE: THIS IS NOT A SURVEYED PLAT. F- APPLK JNIT PICKS OUT UPPER HAL ONLY Property Owner ✓�=i !_ /� -.._J / /. ,r -/.- - 11i / l (C_ ( f :_- Phone Time Date Date Mailing Address :'1 , 1 % '-i!- Zip (:ode Buyer Inspector Inspector Inspector Address Zip Code — Lending Institution ,- Phone - Address Zip Code MUNICIPALITY OF ANCHORAGE Realty Co. & Agent ;-.r/�•�/�- Phone Address Zip Code (AUG / Legal Description / �J i /�-i !/i .4 : Street Location Type of Residence Single Family ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ❑ Multiple Family No. of Bedrooms ...? ( �) DISAPPROVED ❑ Other -- Water apply —— 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 Installed Well To Absorption Area Sewer Disposal Q Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank _Septic Tank Size NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. -P C-1 K`1 rN (2 AV -0 �- A 0; \ Time Time Time Time Date Date Date Date f, Inspector Inspector Inspector Inspector f� r Field Notes: MUNICIPALITY OF ANCHORAGE �- � ��•-� ga «a DEPT. OF H ALTii P, ENVIROi i,V1cNTAL PP.6i ECI IOM �- _- - - (AUG RECEIVED ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( �) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY:-��C_•�-L------- Soils RatingDate Sewer Installed Well To Absorption Area Well Log Received _�_? Well to Tank _ _Septic Tank Size 72 023 131821 tj