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HomeMy WebLinkAboutKASILOF HILLS BLK 8 LT 2AKasi'O I of Hills Block 8 Lot 2A #015-161-56 GRE/ -IR ANCHORAGE AREA BOR 'GH r)) Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME �' P-- MAILING ADDRESS ��rs�T --- PHONE LOCATION L LEGAL DESCRIPTION __i✓5�1C' - —,l _ SEPTIC TANK: DISTANCE OF FROM WELL MANUFACTURER %� NUMBER � -h MATERIAL COMPARTMENTS / INSIDE LENGTH l3 _ INSIDE WIDTH_ __ LIQUID DEPTH LIQUID CAPACITYI(fle-�)GALLONS. TILE DRAIN FIELD: Oyp j / TOTAL LENGTH DISTANCE FROM WELL X44* FOUNDATION _._-NEAREST LOT LINE OF LINES NUMBER OF LINES / DISTANCE BEpTy. EEN LINES y� rp TRENCH WIDTH 2 IN. TOTAL EFFECTIVE /' W �Sd ^9Y' , ABSORPTION AREA 3 Q. FT. LENGTH OF EACH LINE- / DEPTH OF FILTER i DEPTH: TOP OF TILE TO FINISH GRADE C1)MATERIAL BENEATH TILE IN. ABOVE TILE IN. WELL: ' //n0 TYPE/ _CONSTRUCTION BUILDING r NEAREST FOUNDATIONLOT LINE CESSPOOL APPROVED DISTANCES: OTHER SOURCES DISAPPROVED INSTALLED BY:� NEAREST SEWER LINE REMARKS SEPTIC TANK_ DEPTH SEEPAGE SYSTEM_ AGRAM OF S � I umD SEWER LINE DEPTH: r PIPE MATERIAL: LOT SLOPE: REMARKS: U 1pe) E Form EQ -032 DISTANCE FROM: yj �v 07 APPROVED G.A.A. B. GRER ANCHORAGE: AREA BOF J � UEPA,tTMENT OF ENVIRONMENTAL QUALITY e PERMIT - Y 3330 "C" STREET ANCHORAGE, ALASKA 9950, -5, TELEPHONE _ e TELEPHONE 274-4561^ \\VII �lj// ✓ ( 0 tu uw��J SEWAGE DISPOSAL SYSTEM - APPLICATIOND PE 1, —i ✓ r' ,r�� MAILING ADDRESS lJ/')`JCC//1 PHONE--�7! --- NAME OF APPLICANT' I c s l �== /f�/_s" gat' vt ii L INSTALLATION LOCATION�i i 5 1 LEGAL DESCRIPTION - /� INSTALLATION OF: SEPTIC TANK .SEEPAGE PIT DRAIN FIELD OTHER �L'-./'�.1--�' TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY — SOIL TEST RESULTS ♦�1.� NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED�Y�``/ if /V 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 /moi TYPE �L,-{� ` SEEPAGE AREA SIZE t TYPE -- MINIMUM DISTANCES, REQUIREMENTS / FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ___ l ./DRAIN FIELD SEPTIC pts r SEPTIC TANK TO SEEPAGE PIT WALL J / SEPTIC TANK JL6. SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK —e., X13—%) _. SEEPAGE PIT DRAIN FIELD ___/ "t> —. ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK — —. SEEPAGE PIT _ DRAIN FIELD SEPTIC TANK, SEEPAGE PIT �C��. DRAIN FIELD( O -ti 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. / CA GRAVEL BACKFILL CONI -ORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. 7 G.DES OR LICENSEDD DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER DESCRIBED SY EM 'IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM NO. EQ -016 DIAGRAM OF SYSTEM E AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVI k �r ALA ........... eTLAB Hal Graser Realty 401 Last 36th Avenue Anchorage, Alaska 99503 Attention: Mr. Bill Foster 4040 "B" STREET, ANCHORAGE, ALASKA 99503 PHONE: 907-279-2581 February 4, 1975 W.O. #7946 Subject: Soil Analysis Lot 2A, Blk 8, Kasilof Hills Gentlemen: Transmitted herein are the results of the subsurface investiga- tion performed on the above property on January 31, 1975. Exploration consisted of 1-16 foot test hole drilled by Denali Drilling Inc. employing Nodwell mounted, Mobile B- 50 drill, fitted with an 8" hollow stem, continous flight auger. P. grab sample was taken at five feet, by pulling the auger out of the test hole and removing the sample from the flights of the auger_ from near the bit. Standard penetration samples were taken at 10' and 15'. These samples were taken with 2" O.D. split spoon sampler advanced into the soil by the action of a 140 lb. hammer free falling 30". The blows required to drive the sampler each 6" increment are recorded on the logs. The blows required to drive the sampler 12" is, by definition, the standard penetration. The soils were visually classified in the field in accordance with sheets 3 through 5, following the text. This field classifica- tion was verified by visual review and mechanical analyses of the samples in the laboratory. The drilling was supervised and the test hole was logged by 0. M. hatch, geologist/senior technician of our staff. The compilation of the laboratory and field analyses is contained in the test hole log and grain size distribution curves which immediately follow the text. M -W DRILLING, Inc. P.O. Box 4-1224 • 1310C International Airport Road (907) 274-4611 ANCHORAGE, AL-ASKA 99509 DRILLING LOG Well Owner `' Location (address of: Township, Range, Section, if known; or distance main of Well Size of casing Depth of Hole I '"' feet Cased to feet Static water level ft. (41516vO) (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at gallons per (hdur) (minute) for hours with of drawdown from static level. Date of completion Depth in feet from ground surface TO- TO- OTO TO- TO .TO- .TO WELL LOG Give Give details of formations penetrated, size of material, color and hardness W Nii"WA Cez_til'ic�l CJon�ac�h>t ceYtl(icate No's, 2 — STATE 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/onsit6 343-7 onsite ✓/) (907) 343-7904 �+ CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 06— 16 _61 COSA# 10&1 3 1. GENERAL INFORMATION Expiration Date: Complete legal description KASILOF HILLS S/D: BLOCK 8. LOT 2A Location (site address) 10900 STROGANOF DR *ANCHORAGE, AK 99516 Current Property owner(s) TIMOTHY & LINDA LENAHAN Day phone 947-3251 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 10900 STROGANOF DR *ANCHORAGE. AK 99516 Day phone LAURA HALVERSON W/DYNAMIC PROPERTIES Day phone 230-4891 3111 "C' STREET *ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 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 samples. (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 axed 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date D Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines Q Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, 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 are 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 benefit 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. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. . . ....... ....... ess: 13 0 u (Cj 7953 `Fo 4Q�Is �f Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrat dvisory Other By: (,1/'fit% ' l r �f7�1 (Rw. 11N5) Original Certificate Date: Li7 1 Al Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water 8 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 CHECKLIST Legal Description: KASILOF HILLS S/D; BLOCK 8, LOT 2A Parcel ID: 0 A"PIT O 30'. A. WELL DATA PR WELL APPROVED IN 2004. Well type PRNATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 7/15/1975 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 100 ft. Cased to '36.5 ft. Casing height (above ground) "0 in. FROM WELL LOG AT INSPECTION Date of test 7/15/1975 4/9/2010 Static water level 10 ft. 32- Well 2-Well production 5 g,p,m, " 5.6' " " 9•p,m, WATER SAMPLE RESULTS: II Coliform b colonies/100 ml. Nitrate "mg./L. Other bacteria colonies/100 ml. Arsenic:{5• ug./L. Date of sample: 4/9/2010 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material - SEPTIC/STEEL Date Installed 8/28/1975 Tank size 1000 gal. Number of Compartments 1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 4/9/2010 Pumper ISAACS PUMPING C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date Installed _ 8/28/1975 Soil rating (g.p.d./ft'o /bd **150-25 System type TRENCH Length 41 ft. Width 3 ft. Gravel below pipe 9 ft. Total depth *11.4 ft. Eff. absorption area 738 W Monitoring tube YES Depression over field NO For 3 bedrooms Date of adequacy test 4/9/2010 Results (Pass/Fail) PASS Fluid depth in absorption field before test 5 in. Water added 470 gal. New depth 15 in. Elapsed Time: 5 min. Final fluid depth 5 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date *TRENCH IS IS SHY OF REQUIRED 3' COVER. APPROVED AS IS IN 2004. .TRENCH WAS INSTALLED IN 1975. NO FREEZING PROBLEMS ENCOUNTERED IN 35 YEAR LIFESPAN. **PER NOTES IN INSPECTION REPORT. D. LIFT STATION Date Installed "Pump on" level at in. E. SEPARATION DISTANCES Size In gallons Manhole/Access "Pump off" leveNigh water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manholelcleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ 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 10'+ Curtain drain NONE KNOWN Welts on adjacent lots 100'+ 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 JEFFREY A. GARNESS Date COSA Fee Date of 40 Receipt Number Q 8 (Rev. 11/05) Waiver Fee Date of Payment Receipt Number Aarow Pump & Well Service LLC Man Hole Certification 907 346 9355 Man hole at Lot 2A, Block 8, Kasilof Hills was inspected on 4/27/2010. Due to large amounts of snow we were unable to locate drain line but water does not pool in man hole so drainage is good. At last inspection in 2004 man hole met muni specifications and there hasn't been any change to landscape as per owner. Lid for man hole resealed. Vt Municipality of Anchorage • '� Development Services Department Building Safety Division r On -Site Water and Wastewater Program i 4700 South Bragaw St. s • ` T P.O. Box 196650' Anchorage, AK' 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-161-56 HAA # Expiration Date: — O — Q �f- 1. GENERAL INFORMATION Complete legal description Kasilof Hills, Block 8, Lot 2A Location (site address or directions) 10900 Stroganoff Drive, Anchorage, AK Current Property owner(s) Robert & Kimball Mc Ilvain Mailing address Lending agency Mailing address P.O. Box 110155, Anchorage, AK 99511 Real Estate Agent Lori Hackenburger Day phone 346-3222 Day phone Day phone 727-4444 Mailing Address 3111 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q 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 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 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 Watkins Engineering, Inc. Address P.O. Box 110443, Anchorage, AK 99511-0443 Phone 349-1851 Engineer's Printed Name Cindy W. Ellis Date 5-k4 -Of 5. DSD SIGNATURE l/ Approved for bedrooms. y Disapproved. Conditional approval for bedrooms, with the following Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Cindy W. Ellis CE-11osn r '•• �;- =o ' G1N-S1TF Supplemental Engineer's Report Other WATER AND PROGRAM `N By: Original Certificate Date:0 Ll (Rev. 01/02) i• E Municipality of Anchorage �, . p se Development Services De artment t Building Safety Division I, I I ' On -Site Water & Wastewater Program !1 47bo South Bragaw St. i i d 'P.O. Box 196650 :Anchorage, AK 99519=6650 I , 'VAM Mbni.org/onsite I I(907) 343-7904 'I HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Kasilof Hills Blk 8, Lot 2A I ! i i Parcel ID: 015-16-156 A :WELL DATA I, Ii_ I Well ltype IPri If A, B, or'C provide PWSID # Well Logi(Y/N) Y Dateicompleted 71575 Sanitary seal (Y/N) Y Wires properly rotected (Y/N) Y ! Total depths 160 ft Cased to'''36 5 ;j`ft; t Casing height(aboveground) 0 in. I FROM WELL LOG. 11 , ; ' i I I i'` � : AT INSPECTION Date of test 'E 715-75 �4-23-04 � C k ' � � E Static water level 100. i II ft j 36 � 1 .I E i Well production 5` I'! 9 P -m ! 5.0 t' Ig:p.m. I WATER SAMPLE RESULTS: _. ,.OColiflrmhebl1aI �e' nai 0 colonies/100 ml. 11 Arsenic: NA mg./I. 1 Date of sample. 4-29-04 Collected by: IEf Bart Stewart - B. SEPTIC/HOLDING TANK DATA Tank Type/Material steel :II I F ii ! Date installed �8-28-75 i I E 1� Tank size 1000 gal. ! p Number of Compartments :2 Cleanouts,(Y/N) Y. ills I. • I I I Foundation cleanout (Y/N) Y : Depression over tank (Y/N) n High water3alarm (Y/N) NA Date of pumping 4-23-04 r' ;Pumper Isaacs10 E u I� I: C ABSORPTION FIELD DATA lii�'i, I ` Illi' E Date installed 8-2$-75 ;Soil ratin d /ft2 or ft2/bdrm 250' S stem a deep trench 9 (9 P ) Y type I. i,� ,. (; I I. Length 41:j " ft ° Width 13 ! `I;. ft Gravel below pipe 9 ft. 1 ;Ikil.Iz Total depth 11.3 ' ft. Eff ° absorption area 738 ft +Monitoring tube Y � Depression over field n 1, i Date of adequacy test 4 29-04 't ` ' ;; ;Results (Pass/Fail)`PASS ' l For 3 bedrooms 1 t r. ,I, i. �•. i tlk,'i I� I Fluid depth in absorption field before test 0 1 in' •Water added 956 gal E New depth 2.75 in. I !IIS.t � I s i Elapsed Time .75 ' min Final fluid de th in Abso tion rate >=1600 d, i ,Ii All IJ Any, rejuvenation treatment (past 12 mo.) (Y/N &type) I none known - G l If yes, give date — I. II. - i,., li 1� IIr IIII 4 'il 1 Ilr i ! I' rI I � { li, i E �� •� a I� I ��, I I. � C I k I D. LIFT STATION Date Ipstalled NA "Pump on" level at in. Size in gallons Manhol( High water alarm level at in. Cycles tested Meets alarm & E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 102 On adjacent lots 100+ Absorption field on lot 116 On adjacent lots 100+ Public sewer main 100+ Public sewer manhole/cleanout 100+ Sewer /septic service line 50+ Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 40 Property line 25 Absorption field 8 Water main 100+ Water service line 40+ Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 28 Building foundation 50+ Water main 100+ Water Service line 50+ Surface water 100+ Driveway, parking/vehicle storage 50+ Curtain drain none known Wells on adjacent lots 100+ F. COMMENTS W65 �e5' d 441d Was O,e Well is in pit in driveway. It has a steel cover with a proper seal to prevent water influx. Verbally discussed with Jeff Poet. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are In conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Cindy W. Ellis Date 5-15'6¢ . HAA Fee $ 1A Date of Payment L Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number ClOy W. Ellis CE - lose � av 7,3;29 t� 00 W�f x ,� •:. •, , b 0 NGTE . i�taTro►J as: C ����'�� � � L"It1Aw ! INS WELL y� \ O O � MAT U1�6s ��� �� m .: o. CA'' STANOP/PES 0 00 o_ � F � .._ �'UTiLi� T . • a . % F�SEMEN7- �L'�;�� RECE.RTi F I C.I�TIOi�I ...�. ; L Y N?;''` °•'�'^'t NOV. 2.0, 1987 p ,9th IT SHALL 8E THE RESPONSIBILITY 3I«..»�.:. ...» ...� OF THE �S� MA-IAICE �. O)SY:ALO . OWN 613-5 DESCRIPTIONS COVWHICHE NANTS TO PRO TIDE EASEMENT i`O�p~...»....•'',� � ECpRt)Ep SIIBON►S NTN AFPFIIR RON THE ESTRI TIONs QED 8UfLpf PLATURAt)j dNO TO MIFr �'\�.�•u��'o AS B ILT FINISH GqADEAND UTILITY a)N{�MATXW"E S 0 LOT SURVEY CERTIFICATION LEGEND: _Ot .� 910Ck Area $ Ft BrosPippiC:p Monument Q• • Steel "pin ' �,f_ d ,'a Es zfA_J� MeG Survey Hub 8 Tack Not File No. Zoning bistrict= anchorage Recording District, Alaska REVISIONS I DATE BY DIkin9: - aWRL •WAC H' Residence of: 11 4040 0 STRL[T A14CHORA49.'ALASKA 7�: .„ ., Bye Scali • IKQ75R - -� .r S-14-04; 5:21PM; :S Ref.# 1042155001 lent Name Watkins Engineering -oject Name/# Kasilof Hills Bk 8, Lat-3A. 2� lent Sample ID Kasilof Hills Bk 8, Lbt-3f1 atrix Drinking Water VSID 0 mple Remarks: ;907 5615301 2/ 3 All Dates/Times are Alaska Standard Time Printed Date/time 05/14/2004 11:34 Collected Date/Time 04/29/2004 14:15 Received Date/time 0429/2004 15:20 Technical Director Stepp . Ede Released��� Mmeter Results PQL Units Method ContainerJD Allowable Prep Analysis imus Date Date Init Lters Department Nitrate -N 3.19 0.100 .Crobiology Laboratory Total Coliform 0 mg/L EPA 300.0 B (<=10) 05/11/04 JIB cot/100mL SMIS 922213 A (<=1) 0429/04 DKC a (b) Applicant Name ( c ) EE Applicant Address Business Applicant is (check one): Lending Institution k- Owner/builder ❑�; Buyer ❑ ; Other ❑ ; (explain); Lending Institution T �� 6 �U E n �� Telephone Address (e) Real Estal AAAA �. 5. ENGINEERING FIRM PROVID" *: INSPECTIONS, TESTS, FILE SEARCH, I` TA 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. C [(� �f / Name of Firm//Ja mks 5 r ���©�' oC TeIephone Address b J�% gL`Ca2A2K/_/2(� C-6 Date �� GU ©�% • n Note: The well for this property meets existing State and Municipal Codes. There are nitrates present, however, it is suggested that periodic testing be performed to insure the wells continued suitability. En%jriT.kWj concentration is 5.6 mg/1. EPA max imum,,,p�n+gPn;t n is w 10.0 mg/ 1. Jollies F. /�°, ;A 1517 E � AFD nROFESS�n�M1��"' 6. DHEP APPROVAL- ^ �j Approved"for L�� bedrooms by if /0 Date Date Approved k_7 Disapproved Conditional Terms of Conditional Approval dhep CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOP, HEALTH AUTHORITY APPROVAL (HAA) O 6 LIST - FEBRUARY 1984 0S Sp1V\S 264-4720 Rt�N\G\MENjP� Legal Description: A. WELL DATA Well Classification__�! •rC C% If A, B, C, D.E.C. �Approv(Y/N) Well Log Present (Y/N) Date Completed la Ali y�� (J— Yield 5 G- 1e% Total Depth __ Cased to -3t Depth of Grouting Static Water Level _ ail�' — Pump Set At Z 0 Casing Height Above Ground Sanitary Seal on Casing (Y/N) f Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) ��— Separation Distances from Well: ! /(,,-) Z) To Septic/Holding Tank on Lot 2 ; On Adjoining Lots Od To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots /O© L't" To Nearest Public Sewer Line ene— To Nearest Public Sewer Cleanout/Manhole — ie To Nearest Sewer Service Line on I,ot Water Sample Collected by S r zc"/ ; Date l — Water Sample Test Results Comments C1J r vl�E'✓� B. SEPTIC/HOLDING TANK DATA Date Installed ?—iJ Size d 0�/ No. of Compartments _ l Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N)> Depression over Tank (Y/N) - x Date Last Pumped Pumping/Maintenance Contract on File (Y/N) � ;for Holding Tank High Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/HoldinWnk: 1 &� i T(� �C To Water -Supply Well f � � �- To Building Foundation To Property Line — To Disposal Field —� To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA p Soils Rating in Absorption Strata Z, -5 ,f) r o /� Type of System Design Tr cw cls r Date Installed �Length of Field / Width of Field ;;3 Depth of Field '-7 ravel Bed Thickness Square Feet of Absorption Area l Standpipes Present (Y/N) x Depression over Field (Y/N) Al Date of Last Adequacy Test / F ZZ 2 Results of Last Adequacy Test Separation Distance from Absorption /Flpld� ( To Water -Supply Well � 2- i© To Property Line ;?z2 S To Building Founda�tio? �7� To Existing or Ab�pdoned System on Lot *' V d n� On Adjoining Lots To Water Main/Service Line `�/ d� �' To Cutbank (if present) To Stream/Pond/Lake/or Major 6rainage Course A, o e;?P e� "7/ Z&2/ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date In Size in Caflons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes Comm ._Ditrfensions anhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** during Adequacy Test. Meets MOA I certify that have cheg4 e „verified, or conformed to all OA and HAA guidelines in effect on the date of this inspection. Signed Date IIZZI7 Coma .J�✓r% N p y r !dl ��1 � MOA No. Receipt No. /0 D / O U 0 �/ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) NORTHERN TESTING LABORATOMES, INC. 600 UNIVERSITY PLAZA WE -.S]. SUITE A FAIRBANKS. ALASKA 99109 907 479 3115 2505 FAIRBANKS STREET ANCHORAGE. ALASKA 99503 907-2778378 Quality Control Report Client: Sizemore & Assoc. ID#: A110687-3 Listed below are quality control assurance reference samples with a known concentration prior -to analysis. The acceptable limits represent a 95% confidence interval established by the Environmental Protection Agency or by our .laboratory through repetitive analyses of the reference sample. The reference samples indicated below were analyzed at the same time as your sample, ensuring the accuracy of your results. Sample # Parameter Unit Result Acceptable Limit EPA WS 378-6 Nitrate -N mg/L 0.98 0.84 - 1.02 Reported By: Ir,�1AA -Carol J. Garriso _ ice -President Date: 11/12/87 NORTHERN TESTING G I,ABORATO I , W. 600 UNIVERSITY PLAZA WEST. SUITE A FAIRBANKS. ALASKA 09709 907-4793115 2505 FAIRBANKS STREET ANCHORAGE. ALASKA 99503 907277-8370 James Siemore & Associates 6410 Switzerland Drive Anchorage, Alaska 99516 Attn: James Sizemore Source: L 2A D 8 Kasiloff Rills Sample ID#: A110687-3 Parameter Unit Nitrate --N mg/L Result 5.6 Date Arrived: 11/06/87 Time Arrived: 141.5 Date Sampled: 11/06/87 Time Sampled: - Date Completed: 11/12/87 ADFC MCC* 10 Reported By: iC.� Date: 11/12/87 - ------------ -/--------- - ------------_ _ _ _- ---- --- --- Carol J. Garris n, Vice -President * MCC = Maximum Contaminant Concentration 3/-1 � �. Z CK C g m \ 6" 57ANovl,c� j o x CIYA//V X FENCE 4 'ST.QN _ OP/PES / /a U7`iU7y �EASEMEJvT - v�JZYX 1 i� MAURICE P. OSW.ALD i ^jllp' , 613-S AS4 A � LOT SURVEY CERTIFICATION Lot2e , Block Area -- Sq. Ft. Plat File No.=- = ZoniDf.1 District— Anchorago Recording District, Alaska �:I�.�II�iS�i������.^Ji'��_�•1rVt's-----~ ----:I-t �C (T SHALL BE THE PESPONSIDIUTY OF THE MYNER OR GUILDER TO F•RoVIi;E E-^,SL-MENT DE5CRIf'T!oNS, COl'ENA: iT, AN ES TIONS WHICH , r ANO R��fiRIC• n in7 NOT " AR ON THE J PECCRCLD SU` D!VI ION PLAT AN -D Tr) VERIFY F K JYOSED BUILDING GRADE RELATI',(E TO C.r �o n du FINISH GFMDE AND UTILITY CONNECTIONS, LEGEND:_ G) Bruss cap monument O Iron Pipe O Steel Pin Survey Hub a Tack A.o+..-i n 1;1arcT� AL'CI ItAGQ, ALASKA o?�VISIONS� i ')^,T F 3r _ Residonce of;='_J'��1 5. LEGAL D SCRIPTION ?o T /J DATE RECEIVED INSPECTION APPOINTMENTS ' TIME ❑ One ❑ Four ❑ Other TIME 11 TIM�/�' DATE ®Three ❑ Six DATE - DAT'E - INSPECTOR INSPECTOR INSPECTOR ❑ COMMUNITY rvl0la CIPq� TY OF DEPARTMENT MUNICIPALITY OF ANCHORAGE DEP ANCHOR NVIRO L OF & OF HEALTH & ENVIRONMENTALPROTECTION ENVIRONMENTAL NMeNrq� 8. SEWAGE DISPOSAL SYSTEM--� LJ:,,CH7ALT)-f 1>,OrECTI 825 L Street -Anchorage, Alaska 99501 C9� ENVIRONMENTAL SANITATION DIVISION JUL 1980 Telephone 264.4720 REf REQUEST FOR APPROVAL INDIVIDUAL OF WATER AND SEWER FACIL-ITIS"Xf_i, DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER r��J - - PHONE - K �'Jt .J�y- MAILING ADD SS- U. 6o"r `�laZ I- i,/lvq4i!�- 91e CSF' PROPERTY RESIDENT (If different from above) - - PHONE 2. BUYER PHONE MAI LING ADDRESS 3. LENDING INSTITUTION L �7—HO N E D As'7 rr/ti r� Tod MAILING ADDRESS - - - 4. REALTOR/AGENT A / �0L PHONE MAILING ADDRESS — 5. LEGAL D SCRIPTION ?o T /J STREET LOCATIOc_� sxoI/� /1%07 - - - Ole, liG 6. TYPE OF RESIDENCE i NUMBER OF,BEDROOMS it -:r' SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five Cl MULTIPLE FAMILY ®Three ❑ Six 7. WATER SUPPLY- LLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM--� s C9� �G, � rINDIVIDUAL/ON-SITE** — YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. KO[ W 72-010 (Rev. 6/79) ' C 6 n THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septiic TTaankk�or ❑ Holding Tank Sizer If Tank is homemade give dimensions: SOILS RATING t TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 6- APPROVED FOR 3 BEDROOMS' ❑ CONDITIONAL APPROVAL (letter must accaoy certificate) ❑ DISAPPROVED DATE BY MUNICIPALITY OF ANCHORA(' ' 1 DEPARTM T OF HEALTH AND ENVIRONMEI %L PROTECTION C� ���� J 8(.0.L Z`i L Street, Anchorage, Alaska 99'301. ff2,6 279--2511, e,Xt. 224 or 225 ate Received: ^July 18, 1977 �. �(1 : Time :a # 2 : Time #3: '.Gime DateIZ` 1-LeAS Date ._._ --------- Datc, Insp .l(nvL-)ag. T_nsp Tnsp REQUEST .E'OR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES I. Lendi.nq Institution Request: Lomas and Nettleton Company Mailing Address: 4449 Business Park Boulevard Phone. 4: t=,inc3le 2. Property Owner: Thomas M. Peetz TTM _ Phone: 344-7564/hs Mailing Address: Post Office Box 4-112 99509 27'7-6591/w 3. Legal Description: Lot 2A'Block 8 Kasilof Hills Subdivision Family Resid(--nce: (x) Number of Bedrooms; Two Multiple Family Residence. ( ) Number of Bedroom- 5 edroom' --- Well System: Individual Well. i9x) Community/Public System ( ) Permit ## Depth of Well 100' Well. Log on File ( } Construct:i.on Bacteria]. Analysis 6. Sewage Disposal System: On-siLe System kcx) Public Utility ( ) Permit It Installed 3.Z7ntaller ,peptic. lank Size -a/�(5 Q —4 Manufacturer .Absorption Area &cam,/ — Soils Rate�� Material ---�_ 7. Distances: Well to Septic Tank j`(��` to Absorption Area Lo Sewer Line Nearest Lot I ine Absorption Area Lo Nearest Loc Hine MUNICIPALITY OF ANCHORAGE Department of Health and Environmental Pror.dction'i ii 825 I1 Street, Anchorage, Alaska 99501' 2.79-2511, ext, 229, 2.7.5 _- quest for Approval. of: Individual Sewer and Water Fac i.lities j-_. . 1. Property Owner: Mailing Address Phone 2 . Name of Buyer, p�. Mailing Address: Phone: ,. Lending Institut:ion: Mailing Address: 4. Realtor/Agent: Mailing Address: 5. Legal Description: 21CIW If� Street Location: �//� f ��c` 'Ve) —'S%: L�F Phone: Phone: 6. Single Family Residence: Number of Bedrooms: C Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well (Pl' Public/Coirumznity System ( ) if Individual Well-, well depth If Community System, name of system 8. Sewage Disposal System: On-site System Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALS, wells drilled since 6/75. 3/77 Page Two Depai:l-ment. of IIeal.Lh and Environmental Protect—.ion ]:request for Approval of Individual Sewer and Water J. aciAiLies Legal Description: �o�2A_B19�k8_.IC�si�_Of_.F) 11 zl����es,aon_ Comments: hi L;adavi..L AU--achcd= ( ) +>i:t.e Attac,hcxi- ( ) Da to D .;,approved : I�atn_ : De,pa:,tment- worksheats n