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HomeMy WebLinkAboutKASILOF HILLS BLK 7 LT 2, KIASLOF HILLS B10 k 7 Lot 2 #015-161-11 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221467 PID Number: 015-161-11 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name Stephanie Mathers ABSORPTION FIELD ❑ Deep Trench ®Wide Trench El Bed El Mound Site Address 10881 Stroganof Dr. ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.45 GPD/SF 7.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.95 Ft. Gravel depth beneath pipe 4.05 Ft. Subdivision Block Lot Kasilof Hills 7 2 Fill added above original grade 1.38 - 2.45 Ft. Gravel length 101 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1010 Ft z 1 Ft. Well I 1001+ I j 25'+ K ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufac er Existing Tank Capacity I Surface Water 100,+ Gal. Material Number of compartments Lot Line I 10.1' f NA Foundation I 10'+ LIFT STATION Manufacturer Cap 'ty Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank Tank to drainfield D3034 Northern Excavation Drainfield D3034 CO/MT D3034 Inspector Areterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection n dates: 5/30/23 2"d 5/30/23 Location and description 3rd 5/31/23 41h 5/31/23 Bottom SW cantilever corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date e tit 44 4ti4 *� X 491h M Septic System Approved Date /Z �z3 �. �s KENNETH M. D S 4.a C 711 � ♦�� Note: this approval does not include well permit requirements. .• (Rev 05/02/18) AS -BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP221467 KASIL❑F HILLS BLOCK 7 LOT 2 PID# 015-161-11 ti =a•' , Y a EXISTING BUILDING 1 • a // _ FCO a DECK TH-T - a :4A • E I/ r� Q Y• I a � Ohl -2 .a F �7 N y �u LE, 1' = 30' A -C=66 3' B -C=60.3' A -D=67.5' W B -D=61.9' o A -E=53.4' B -E=68,5' & A -F=66.7' B -F=91.7' o A-15=68,5' y B -G=93.6' 1 M W W W . o po (� 0 0 W Z O2•�S 0 0 0 QFINAL GRADE Rr� FILTER FARFM N2031=10119124 _+74h 101- zn or < OF �' PREPARED FOR: Lu t STEPHANIE MATHERS a •�. 10881 STR❑GAN❑F DR * : 4 9 * ANCHORAGE, AK r 4 -► D S / RELD BOOKS COMPUTED: —71 B 4 )0 BOUNDARY: N A KSC� a 1�7 !mo w. STMNG- N/A CHECKED: KMD I ASBUILT: LANG DATE 6 21 2 E ,FESSI4�� DWG. FILE GRID: SW2641 ■-_� ACAD FILE FILE NO' 22173 +.os• 67,33 DW �2 66.33 M' �/M SCALE! NTS o p,�cTeRR� ARcTERRA ' CONSULTING, INC = 20441 Ptarmigan, Eagle River,AK 99577 i Office (907) 696-6111, Fax (907) 868-3793 SOILS PERCOLATION TEST Performed for: Stephanie Mathers -dW- -%�'If*,\ 1* 4 ' KENNETH M. L •'lid / 7116 Nrt� 7 Z AV Date Performed: 5/29/2023 Project: Kasil.of Hills Block 7 Lot 2 PERC #1 _ _ _ TEST HOLE # TH 22-2 Depth (Feet) SEE ATTACHED SITE PLAN ORG 0'- 0'6" 1 -7 ! -FOR HOLE LOCATION GM 0'6"-13' 6- 8- 11- 12 14- W,B.O.H. 14' 15- 16- 17- 18 - HOLE PRESOAKED 19- PRIOR TO TESTING Was Ground water encountered? No Depth to water after monitoring? (Depth below grade) What depth? NA Date 5/29/23 Reading Date Gross Time Net Time Depth to Water Net Drop 1 11/04/22 12:30 _ 4 14/16" - 2 1:00 1 30 min 4 2/16" 12/16" 3 * 1:00 - 4 14/16" 4 1:30 30 min 4 2/16" 12/16" 5 * 1:30 - 4 14/16" - 6 2:00 30 min 1 4 2/16" 12/16" 7 * 2:00 - 4 14/16" - 8 2:30 30 min 4 2/16" 12/16" 9 10 11 12 * Water Added Percolation Rate 40 (min/in) Pere Hole Diameter 6" Test Run Between 3.0 feet and 3.5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. I 10' UTILITY EASEMENT Lot 3 I I I I 30.0' { I I CHAIN-LINK FENCE I N 86-45'21"E 228.53' WELL' x x ` 44- Q ' WOODEN FENCE O�V6 ' - 1 12.3'x12.3• W �O 24.2 SHED I 00 / Q 3.7'x5.7* = q Lot 2 \ PORCH 35,998 S. F. I o ^�- '^"� V) .1. NIT n U o•: N_ x x X DECK �` I x 00,% SEPTIC +L� PPIPES D DECK SEPTIC PIPES / \ X 6• FEN E LINK I •r 55 0512 \ + Lot 1 PLOT PLAN —__ AS BUILT X_ SCALE: _ 1" = 40 _ GRID SW 2641 Project No 23-22�A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associaties, inc. (907) 522-6476 Phone 4QoF 4� 4 (907) 522-4625 Fax Qo Professional Land Surveyors kenQlangsurvey.com O Jonathan®langsurvey.com I hereby certify that I have surveyed the following described property: LOT 2, BLOCK 7, 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 , ���—__—___ --- 1,�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* �Ql .............................. � AN -14 IG o� Le �� � 04��AFa ' .. LS -520 . • ' C-3 g7 �O�R�FFSSIONAL ��-� 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: OSP221467 Work Type: Septic Upgrade Tax Code Number: 01516111000 Site Legal Address: KASILOF HILLS BLK 7 LT 2 G:2641 Site Mailing Address: 10881 STROGANOF DR, Anchorage Owner: MATHERS STEPHANIE & Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 'IR llicnt 11 v Departin ent 11/23/2022 11/23/2023 35998 Q Disposal Field ❑ 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 Special Provisions: 1. An additionalpercolation test is required prior to construction of the septic field. Please submit stamped and signed results withthe As -built Inspection Report. If theresults require a design change, construction of the system will stop pendingOn-Site review and approval. 2. The existing seepage pit is to be decommissioned per code. ,i may:►�C / e i Date: Issued By: /t el— Date: 3 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section -' Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-161-11 Property owner(s) Stephanie Mathers Day phone Mailing address _ _ 10881 Stroganof Dr. Anchorage, AK Site address 10881 Stroganof Dr. Anchorage, AK Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Lot Size 35,998 Sq. Ft. Number of Bedrooms 3 Kasilof Hills B7 L2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ® Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank ❑ Upgrade Duplex ❑ (D) Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: /s *357 Waiver Fees: Date of Payment: f ! NI Z2 !1/iy Date of Payment: Receipt Number: 0(a C16 _�6 ©7zo4eceipt Number: Permit No. 05 P Q� lg(a? Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221467, Deb Wockenfuss, 11/23/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221467, Deb Wockenfuss, 11/23/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221467, Deb Wockenfuss, 11/23/22 None Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221467, Deb Wockenfuss, 11/23/22 Lot 3 10' UTILITY EASEMENT W F - Q 0 /"1L1 A IAI 1 IAII/ CCAInC Lot 3 10' UTILITY EASEMENT W F - Q I hereby certify that I have surveyed the following described property: LOT 2, BLOCK 7, 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 _ 1�_ Day of _!'ovem�f r ___, 202 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. *48!H- TRAVIS A. WILSON4t�AO / No. 156408 �J PROfESSIONA����� State of Alaska AECC963 PLOT PLAN ___ AS BUILT _X_ SCALE _ 1" _= 40__ GRID _ SW 2641 Project No. 22-7L51R1_r_ La ng & Assocates,i� n (; . 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone Land -- - SuryeYors (907) 522-4625 Fax kenOlangsurvey.�om q��ProfessionaI OFAt tjonathonAlangsurvey.com����� �.P. A' • .Mfr- 1, I hereby certify that I have surveyed the following described property: LOT 2, BLOCK 7, 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 _ 1�_ Day of _!'ovem�f r ___, 202 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. *48!H- TRAVIS A. WILSON4t�AO / No. 156408 �J PROfESSIONA����� State of Alaska AECC963 ,. GRE ER ANCHORAGE AREA BOI GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 SEPTIC TANK: DISTANCE / NUMBER OF FROM WELL MANUFACTURER S 1 ©ia _MATERIALC-c)y%CeP -c COMPARTMENTS INSIDE_ LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY -/z6-69. .-GALLONS. SEEPAGE PIT: NUMBER OF PITS ! DIAMETER OR WIDTH A, LENGTH 7, DEPTH LINING MATERIALCWC </ J CRIB SIZE: DIAMETER__DEPTH_6�_ DISTANCE FROM: WE-7LL/ JI. tTOTAL EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE 2p. ABSORPTIONA AREA (WALL AREA) 3 / SQ. FT. A / ADDITIONAL ABSORPTION -50 WQ'aZ / Z q ✓1%L WELL: TYPE r6 _CONSTRUCTION BUILDING NEAREST FOUNDATION—,LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES: Ac " -z3, e, ca Vi INSTALLED BY: C))GICK ' j I PIPE MATERIAL: r -s' ` LOT SLOPE: REMARKS: Form No. EQ -031 DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE -,TANK / SYSTEM ri� REMA DIAGRAM OF SYSTEM ►def I $2. Si1u�lP. rs I� J. y =y4 N —� Ok- (-I--_ DATE �' �G/"'_�_ APPROVE INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME _ O b.{V O b -� MAILING ADDRESS ��e)Z 4 ols !/�� L.00ATION��/ yDj� 461 Y� 64-W0' n_ C� LEGAL DESCRIPTION A'2 e2 �iPHONEZ/ SEPTIC TANK: DISTANCE / NUMBER OF FROM WELL MANUFACTURER S 1 ©ia _MATERIALC-c)y%CeP -c COMPARTMENTS INSIDE_ LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY -/z6-69. .-GALLONS. SEEPAGE PIT: NUMBER OF PITS ! DIAMETER OR WIDTH A, LENGTH 7, DEPTH LINING MATERIALCWC </ J CRIB SIZE: DIAMETER__DEPTH_6�_ DISTANCE FROM: WE-7LL/ JI. tTOTAL EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE 2p. ABSORPTIONA AREA (WALL AREA) 3 / SQ. FT. A / ADDITIONAL ABSORPTION -50 WQ'aZ / Z q ✓1%L WELL: TYPE r6 _CONSTRUCTION BUILDING NEAREST FOUNDATION—,LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES: Ac " -z3, e, ca Vi INSTALLED BY: C))GICK ' j I PIPE MATERIAL: r -s' ` LOT SLOPE: REMARKS: Form No. EQ -031 DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE -,TANK / SYSTEM ri� REMA DIAGRAM OF SYSTEM ►def I $2. Si1u�lP. rs I� J. y =y4 N —� Ok- (-I--_ DATE �' �G/"'_�_ APPROVE „o,,, GREATER ANCHORAGE AREA BOROUGH J'� qPi 6 DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C” STREET ANCHORAGE, ALASKA 99503 ' TELEPHONE 274-4561 '�,,.o'. SEWAGE DISPOSAL SYSTEM ® APPLICATION AND PERMIT NAME OF APPLICANT W V ✓ (/ v V / y /I MAILING ADDRESS � v (/' ✓7�I 441 INSTALLATION LOCATION �C '��'//!1 , LEGAL DESCRIPTION i ` INSTALLATION OF: SEPTIC TANK EEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED 1/f - PERMIT NO L_o ;5'& Z7Z-07`1-7 PHONE _- DRAIN FIELD ./, OTHER FINANCED THROUGH TO BE INSTALLED BY J�--._._�-- - SOIL TEST RESULTS .� `"ti- NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRCD. BACKFILLING OF' ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL. QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE L6�O- - TYPE E AGE AREA MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT / DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALT_ SEPTIC TANK SEEPAGE PI'T ZIP DRAIN FIELD' TO NEAREST LOT LINE. WELL TO SEPTIC TANK _ . SEEPAGE PIT ,/D r DRAIN FIELD /Q Q ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK( . SEEPAGE PIT _ DRAIN FIELD SEPTIC TANK, ..�/ C/ O SEEPAGE PIT /y Q 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 TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. � OR LICENSED DESIGNER DIAGRAM OF 02 ed ✓a c A, — I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. f DATE �/ i APPLICANT'S SIGNATURE /f; _ 60nsfzuction lest -faf "One test is worth a thousand opinions" 0820 TUDOR ROAD. ANCHORAGE. ALASKA 99507 • TLLMIONC 333.8472 Performed For Bob Hobson Date Performed 4-29-74 Leaal Descrintion: Lot 2 Block 7 Subdivision Kasilof Hills This Form Renorts Soils Log Yes Percolation Test Oenth Feet Soil Characteristics _ 1 Overburden 2 _ 3 _ Slope Deposits of Poorly Graded to Well Graded Gravels with some sands, q silts and clay layers 5— GW -GM 170 H e This soil test was taken on a road cut below the proposed homesite. Bedrock in this area is most likely R 6 ft. below the intended seepage pit however this will be determined g.- when the actual seepage pit is being excavated. 10 Was Ground Water Encountered? no If Yes, At what Depth? OF0.0 P i 1 C,i Reading Date Grass Time Net Time Depth to H2O Net Drop' — Percolation Rate Minute Proposed Installation: Seenaae Pit yes Drain Field Depth of Inlet Depth To Bottom Of Pit Or Trench COMMENTS: 170 sq. ft. draiange-area required per bedroom �— Determination of bedrock will be determined when owner —' excavates the seepage pit. LOCATION OF WELL (Please complete either la, Ib or Ic.) la. Borough I Subdivision Lot Block Ib. 1/4 gtr s. JTB 0Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Street Address and Area of Well Location WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. A.D.L. No. Section No. TownshipN171 Range E[] Meridian SEl WC] 3. OWNER OF WELL; Address: 2. WELL LOG Feet Below Surface Material Type Top Bottom 4. WELL DEPTH: (final) ft. 5. DATE OF COMPLETION 6. Cable tool Rotary E] Driven Dug ❑ Auger Jetted C3 Bored [3 Other: 7. USE: 0 Domestic E] Public Supply Industry C] Irrigation [3 Recharge Commerical F1 Test Well ❑ Other: 8. CASING: n 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 Slze: Length: Set between ft. and ft. Backfilling Gravel pack — _ ANON -- ml OF SL 10. STATIC WATER LEVEL ft. Above orBelow land surface Dote Equipment used: II --- �FpT. OF OTE ION -- OD I I . PUMPING LEVEL below land surface and YIELD ft. after hrs. pumping g.p.m. ft. after hrs. pumping g.p.m. 12.GROUTING Well Grouted: O Yes n No Material: E] Neat Cement E] Other: G, f, 13, PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. Subm. Jet EJCentrifical Other C cn Cnn r - o Z J �� X0 14, REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 5. Water Temperature _ 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 Signed . Date: Authorized Representative Form 02-WWP (II/81) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY -Customer o O F Cl C MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval to 1 Z 202, 3 Parcel I. D. 015-161-11 Legal description Kasilof Hills Block 7 Lot 2 Site address 10881 Stroganof Dr Anchorage Current property owner(s) Stephanie Mathers Expiration Date: �— 2 The On-site system(s) is/are approved for bedrooms - Conditional approval for '� bedrooms, with the following stipulations: Comments or advisories: OSP221467 has been issued to construct a new septic field. This work is to be completed and permit closed out by June 15, 2023. Original Certificate Date:__LU2_34�^ 7l /.2 zQ23 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovMjune 2022 RUS# MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcell.D. 015-161-11 Complete legal description Kasilof Hills Block 7 Lot 2 Location (site address) 10881 Stroganof Dr. Anchorage, AK Current property owner(s) Stephanie Mathers Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: © Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ® Concrete ❑ Fiberglass Age 48 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $Qt a�•oC Waiver Fee $ Date of Payment t t /at [ aoaa Date of Payment COSA # 6.5c #;-21550 Waiver # #_ 66(a09�= COSA Application—June 222 Legal Description: ___ COSA Checklist Kasilof Hills Block 7 Lot 2 Parcel ID: 015-161-11 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 10/6/86—Total depth 180 ft Cased to 26 ft ✓❑ Sanitary seal is functioning correctly ✓❑ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 10/27/22 Static water level at beginning of test 40 ft. Comments _ B. TANK DATA Measured operating fluid level in septic tank 48 Date of pumping 11/2/22 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/31/23 W ALL standpipes present per record drawing Total measured depth from grade 9.02 ft (max) Measured depth to pipe invert from grade 4.33 ft (min) ❑ N/A - pressurized field. ❑ Per record drawings, field is insulated. ✓❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies *New 5 wide COSA Checklist June 2022 Well production at time of test 6.0+ qpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes 21 No ✓❑ Coliform bacteria is Negative Nitrate 3.96 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ✓❑ Arsenic less than MRL (ND) Collected by Arcterra Consultina- Date 11/4/22 STATION ❑ Require <b Age of lift station _ Lift station material Comments: completed Adequacy test date Resuits ❑ Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final Fluid depth in Absorption rate gpd FIELD STATUS - POST RECOVERY Effective depth (per record drawings) Effective depth used in Effective depth remaining in In E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ❑✓ Yes if No xx Community Sewer Manhole/Cleanout > 100' ✓❑ Yes if No ft ./❑ Yes if No Neighboring Tank > 100' ✓❑ Yes if No ft Private Sewer/Septic Line > 25'✓❑ Yes if No Absorption Field on Lot > 100' 21 Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Yes if No Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft ❑✓ Yes if No ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No xx ft Surface Water > 100'✓❑ Yes if No _ Tank to Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑✓ Yes if No ft Private Wells > 100' Yes if No _ Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' Q Yes if No _ Water Service Line > 10' ❑✓ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *'Concrete tank located under deck and exact separation is unknown. Not under deck foundation post. ft ft ft ft ft ft ft ft G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Areterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date _�&1 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. OF The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The '���� Nj�** flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year ; and the water usage of the family being served by the system. The operational life of all well and septic Z * �g m systems are subject to these various and dynamic characteristics and are outside the control of the evaluator: of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will 0 function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies existKENNCTFI M U E JS CE 71 AN 0 COSA Checklist.. June 2022 • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-161-11 1. GENERAL INFORMATION Complete legal description IV,,Qr SXFEiY Expiration Date: 6 _ —2, 3 '- / S Kasilof Hills, Block 7, Lot 2 Location (site address) 10881 Stroganof Dr. Current Property owner(s) Donald Reeves Mailing address Real Estate Agent Day phone 240 E Tudor Rd. STE 210 Anchorage, AK 99503 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well (] Individual Fxl Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 3 L I 116 Date of Payment Receipt Number CJ3UC� Receipt Number COSASIC/, 167(19Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty. for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit Of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for —� bedrooms bedrooms Date 3/17/2015 �,tig:gg TH *i � �e C 8.8149 one bedrooms, with the following stipulations: By: �� g !f� Original Certificate Date: The Mun— Ity of nchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. - ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other QOSA blue sheet_t ., .. If more than 1 septic system is on the lot: COSA Checklist# + of 1 Structure served by this system I T Certificate of On -Site Systems Approval Checklist Legal Description: Kasilof Hills,, Block 7, Lot 2 A. WELL -DATA Well type Private If A, B, or C provide PWSID # Date completed 10/6/1986 Sanitaryseal (Y/N) Y Total depth 180 ft. Cased to 26 ft. FROM WELL LOG Date of test 10/6/1986 Parcet4D: 0 .5'161-11 Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 18+ in. AT INSPECTION 1/23/2015 Static water level 59 ft. 42 ft. Well production 10 g.p.m. 7.4+ 9.p -m. L WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 2.29 mg/L Arsenic ND ug/L Date of sample: 2/27/2015 Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Concrete Tank size 1,250 gal. Number of Compartments PES Date installed 8/19/1974 1 Cleanouts(Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YM) N High water alarm (YIN) N Date of pumping 1/21/2015 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 8/19/1974 Soil rating (g.p.d./ft2 or ft2/bdrm) 170 SF/BR System type Crib Length 17 ft. Width 16 ft. - Gravel below pipe 8 ft. Total depth 1 9 ft. Eff. absorption area 528 ftz Monitoring tube Y Depression over field N Date of adequacy test 1/23/2015 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 498 gal. New depth 0 in. Elapsed Time: '70 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N $ type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at in. -Datum Size in gallons "Pump off" level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank1lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ SEPTIC/HOLDING TANK ON LOT TO Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ I?6lding tank 100+ Manure/animal excrete storage areas 100+ Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ F. COMMENTS As -Built on File LS,.e -4e.Lz� +s4-„% A cz:6 rfcLrreri. AUcd bCo. G. ENGINEER'S CERTIFICATION I certify that / 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 Steven R. Pannone Date 3/17/2015 COSA brown sheet 10-10-12.doc in. Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015=161-11 HAA# D� Expiration Date: cl o 1. GENERAL INFORMATION Complete, legal description _Lot 2; Block 7; Kasilof Hills Subdivision .Location (site address ordirections) 10881 Stroganoff tWxyz_ 'Current Property,owner(s) Jonathan Simmonds Day phone 346-1385 Mailing address same Lending agency Day phone Mailing address Real Estate Agent Pete Cholometes / Pruden tiaibay phone 727-6464 Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. , G�3 c /o y 2.'. NUMBER OF BEDROOMS: 3 3. TYPE OFWATER 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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 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 ora ipublic 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. Name of Firm S & S Fngi nP__%ri ng Phone 6--9 4-29-79— Address 17034 N Eagle River Loon Ste 204 Eagle River,AK 99577 Engineer's Printed Name Robert C. Cowan Date 5. DSD SIGNATURE Approved for Ise Disapproved. Conditional approval for _ Additional Comments OF .4 /)9 )ry iv ERT C. COWAN CE -6801 bedrooms, with the following stipulations: l l`ltt<<vWMNf jj Wo ON-SITE • WATERA D •,R' ;ASIEWATFR :. PROGRAM Attachments: HAA Checklist X Maintenance Agreements, Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other BY: Original Certificate Dater G - - (Rev, 01102) Municipality of Anchorage E Development Services Department Building Safety Division j 75 On -Site' Water & Wastewater Program 5 A F . Y 4700 South Bragaw St. P.O Box ;196650 'Anchorage, AK 99519-6650 www.ci.anchorage.ak.us ;I (907) 343-7904 ' HEALTH A UTHORITY APPROVAL CHECKLIST Legal Description: Lo - Q La Gcc 7 J61 StLoF ------------------------------- It IL -�� +' arcel ID: A. WELL DATA Well type Ll v1qY4- If A, B, or:C provide PWSID # Well l_09 (QdN) Y X, Date completed /0/6/5'� �48an'a eal N Y�1 + ry s & ) .I Wires protected &N) '''f -J Total depth ��� ft, Cased to ft properly Casing height (above ground) f- in. Ij FROM WELL LOG AT INSPECTION. Date of test ) 0 l G :$ / J Static water level S ft. i' ' E! Well production /0 g•p•m• ft• 7, , ;yc E` WATER SAMPLE RESULTS: g.p.m. '1,- M, Y-La� 3rj'i y y,a i,VM� � vc Coliform �: D colonies/100 ml. Nitrate 3.3 c� mg./I..Other bacteria colonies/100 mL Arsenic -� mg./I. Date of samplerdiyk i l i , Collecte IWIS ENGINEER! B. ;SEPTIC/HOLDING TANK DATA 17034 Eagla River Loop Road No. 204 /M Tank Typeaterial '5/t0 TC.A i r� Eaglo'River, Alaska 99.577 Date installed _ i g// q 7 y a 0 Tank size I:gal. Number of Compartments Cleanouts (�N) Y' ' f Foundation `I leanout/N) YE De pression over t ank (Y�j o {i High water alarm 0 L , R Date of pumping -J ° Pumper i S A fl c s + i. (Yy .�. ; ... a C. ABSORPTION FI ; ELD DATA Date installed 8I °) /7y Soil rating 2 g (g.p.d./ft /bdrm '17 i) System I � type G�' a Length i f:I 17 ft. Width ft. Gravel below Pipe ft. Total depth I ft. Eff. absorption area 3 9 ` ft2 Monitoring tube Vf J -Depression over field Date of ad6quacy test G1,Y/0 I 1 �' ResultsPa Fail 'PA ) -r 1 � - For 3' bedrooms Fluid depth m absorption field before test Dai in. Water added s -G3 gal y , ;' New depthin i.I Elapsed Time: 0 min. Final fluid depths Absorption rates,>_ S'0 d. 9P An rejuvenation Y J treatment ' Its o N w K Nowa/ (past 12 mo.) (Y/N & type) Ifyes, give date I: ff D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off level Datum E. SEPARATION DISTANCES tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot )00'--, Absorption field on lot Public sewer main F. I11 II M ccess (Y/N) i 1111 in. High water alarm level at i j iln. 'Meets alarm & circuit requirements? .. - t i� I On adjacent lots On adjacent lots ' Public sewer manhole/cleanout orption field 1 I I 1 + f.I 4water- ON o I� II J - f,' � � � Surface water� I l ON LOT TO. I I IO 4- Water main Oy — Driveway, parking/vehicle storage rO � I il, a sll J0 o I r�,`•�,•,••..•.....,..,,t1��`a I;. II ;III I i= S y' •Ili ' : ` � I I I •.M•• u•• � �' it ail Ij�l� '�'EI �f /ill and ...•. —• -.. V:: I. I i' III I, : , e in : ROBERT C COWA I 44, i Sewer /septic service line -d-s-, .4 Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:, Building foundation S- l -t- Property line's Abs Water main N IA. Water service line Wells on adjacent lots J O O f SEPARATION'DISTANCE FROM ABSORPTION FIELD f Property line':. / 0 Building foundation Water Service' line'10,-f- Surface water Curtain drain'NaN* K1J0w,%1 Wells on adjacent lots COMMENTS G. ENGINEER'CERTIFICATION 1 certify that l have determined through field inspections review of Municipal records that the above systems ar conformance with MOA HAA guidelines in effect on this date. SCE : 880 ': •, r=" ��/� � ` - Engineer's Printed Name I'll I P !I'I, /o`f=��z-a�-"''III i Date r C i l Waiver Fee $ lr, HAA Fee $ J4 3 tl I k I I� Date of Payment ! 0"Y Date of Payment j t i I: I' i'lll`I f j l I a- � t I I, Receipt Numble!r: 'I ©S Receipt Number � - I. I III (Rev. 12/01) x 71 i I o I kG , 'Y t I ' i l I I z *ON 03� M7 LQ P� Olt N � N 0 3 „00,00.00 S r• yg 0 Nr gam•',. •: .fir, '" � ''• � r i � r tit Y � , Fts55�•�1 ROGANOF DRIVE r i l � MUNICIPALITY OF ANCHORAGE Q*11 Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE= SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ©� J — l La L — L 1 HAA # W R1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) 094t S9' o�A (b) Property owner a? 0 *�SSoIIJ Telephone: (home) — Business Mailing Address 10841 S MQ &A N10`11` (c) Len nstitution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: 3'3-1P 1121 2. TYPE OF RESIDENCE Single -Family Ix Number of bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to 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 legailty 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 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 k N k E Feel E J 610 V10G`relephone 377, k kl. Address 8 44� ►`-#\�� %✓rS CuHTL Date 7 —" 1 \ % 0 6. DHHS APPROVAL Approved for Approved �— ✓ �_— 7 bedrooms b � ` "� Date ��,57/%L, Disapproved 5%C- 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 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7188) BacR Page 2 of 2 G� � N ORPpS���\� MUNICIPALITY OF ANCHORAGE (MOA) .�� ����P� i a� CHECKLIST Health ritFEBRUARY y Approval 11) 984 343-4744 Legal Description: �� ISI6®lg I t• 10841 5MO&ANJa� A. WELL DATA Well Classification P(Z-%V tM If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) y Date Completed ( ()AI& Yield— 10 J D_i M Total Depth 18 Cased to 4(V Depth of Grouting w 0K. Static Water Level —Ap _ Pump Set At C4 W 14. Casing Height Above Ground M Sanitary Seal on Casing (Y/N) V Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: I To Septic/Holding Tank on Lot 10-7 ; On Adjoining Lots % too To Nearest Edge of Absorption Field �A on Lot { ?,; On Adjoining Lots 14?t Do To Nearest Public Sewer Line N! To Nearest Public Sewer Cleanout/Manhole VIA To Nearest Sewer Service Line on Lot — 9b Water Sample Collected by L ; Date Water Sample Test Results TpE �h� rrwa! 6� Comments C B. SEPTIC/HOLDING TANK pATA Date Installed I q I+ Size � �� �® No. of Compartments Standpipes (Y/N) yAir-tight Caps (Y/N) Foundation Cleanout (Y/N) y Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contact on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) 0 Temporary Holding Tank Permit (Y/N) 11 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: i To Water -Supply Well 10 To Building Foundation _ To Property Line �? ZD To Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course '7 l is 0 � Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ® Type of System Design Ir6Lf DA &n_15 ID,, 'C --- Date Installed �� 4" Length of Field _( Width of Field / Depth of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Gravel Bed Thickness Statndpipes Present (Y/N) OF Date of Last Adequacy Test r 2.— 5C-i� SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well t 2. To Property Line To Building Foundation Lot 13 .33 ; On Adjoining Lots To Water Main/Service Line 90 To Cutback (if present) To Existing or Abandoned System on � too To Stream, Pond, Lake, or Major Drainage Course ? ( oA / To Driveway, Parking Area, or Vehicle Storage Area % 40 Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Cod Comments Dimensions Manhole/Access (Y `*Check Permitted Bedroom Rating Against HAA Request*" "PumoSaf+"Cevel at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, conformed to all MOA and HAA guidelines Jn,effect on the date of this inspection. Signed Company �r1t��-`tile l�1JGtt���1\?(a Date 0 — l 1 — 90 MOA No. 010 —030 Receipt No. a U .3y L)-3�6- ,/ Receipt No. _ Date of Payment �7 _/ 0 �l U Waiver Fee: $ Amount: $ U Date of Payment 72026 (Rev. 7/88) Back Page 2 of 2 TZIM &t KNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 • Fax (907) 338-1874 HEALTH _AUTHORITY _RESULTS _ AND_ANALY;IIS Date of Testing:. July 2, 1990 Legal Description: Lot 2, Block 7, Kasilof Hills Street Address: 10841 Stroganof Number of Bedrooms: Three (3) ----------------------------- --------•------------------------------- Results of Well Flow Test: L'aasp_rl Sustainable Flow Rate: > 5 qpm --------------------------------- Results of Water Quality Analysis: Passed Total Coliform -- 0 colonies Nitrate -N --- 2.1 mg/l (10 mg/l allowable) Testing Laboratory: Northern Testing Laboratory Anprov_al_ The well is connected to a 11000 gal storage tank due to very low flow rates in the initial well system. The well was extended at a later date with the result being the substantially higher flow rates. For testing purposes, the float system on the tank was; set to provide continuous fill during the drawdown period. The in-line filters were bypassed, in order to provide an accurate rating for the well capabilities. The well started with a static water level of 76' depth, was drawn down to the 103 foot depth during the test, and recovered to the original static level within 25 minutes after the flow test was stopped. The wastewater system was tested by flooding the crib area with 453 gallons of water in a 37 minute period. No rise in the water level in the crib was noted. The soils test for the original installation shows soil ratings of 170 sf/bedroom, or a total of 510 sf for this 3 bedroom house. The wastewater system was design for a two bedroom system, but was field constructed to accommodate three bedroom (16' length x 17' width x 8' depth = 528 s -F of disposal area). The tank is of 11250 gal. size, large enough for a three bedroom design. TlDe_wpll__and__ssptic___system__test.iny__show__they__are adequate_for_a_three _bedroom _desi:gn_