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HomeMy WebLinkAboutEAGLE ROCK LT 25CEngle Rock Lot 25C #075-092-70 Oct -20-06 01:37pm From - T -334 P.001/001 F-106 Waiter Wel('Drilling (ttd Airily, Ser%*a Well Log An {70Yntid, 'RIASI t �nOJ) 7)S'JS:�: 11 /�r� r� rip llrillinu Starlc0: 10;082008(',,117pie,vd: 10,,09 2008 C'i,yr l3urou h: 5rybtlivision: BLOCK LOT Pro(mrty O,vncr Nume& Addmss: Kristian Sieling P•,O. Box 92 Site:Wadonia Way Glydwood, AK 99587 Girdwood Eagle Rock 25c .Meridian i owwhip Ran c Section I/4 of _ 4 of _ _ YJ of BOREHOLE DATAffrom top of easingpepth Drilling method: (X) Air roctry. t ) Cable tou), Orher __ _ ..... Material: Type, Calor &wvuless Fran, To Well use: ( ) Public supply. t X) DomLslic, Other _.. — stickup 0 2 Depth 01'1101C. 104 li, casing stickup; .— --f, Casing rypc:Steel _ Thickness: _.250inches Overburden 2 4 easing diamerer: ,.._ 6.--. inches c' mmil (omni: _ 104 ft Liner type: �__ Diameter: _, inches Depth: li gravel w/ clay 4 12 Stade walcr(from top ofmiog):.84__•. ti on 10'09, 2008 Pualping Ivvel S Vivid: ficel atter lours al gpm _ — .. Recovery rate: 155 gpm, Method al'tes(ing: airlift Development method: airlift Duration: 1 hour _ silt &gravel 12 38 wet silt & gravel 38 43 Wolf intake opining Type: (X ) Open end. ( ) Open hole, Other. 4crcenl.d; Start: - 11, Stopped. silt & gravel 43 94 Screenty�(tc - Slotimesh.ize: Performed: Scut:,,_,_ - Il, Stopped: _... -_---_- .- ....... ll wet silt & gravel 94 100 Start: --__. — n, stopped: ._.__._-_.__ li Note: ................................................... gravel w/ H2O 100 104 Grout type: _ _,tntonite volume neplh: from ground surface , to 2.0 ._ t Pump inmkc depth: ........... li Pump size: - hp. Brand name: Was well dis(nfemed upon completion? ( X) Yes, ( 1 No Mctlod of duinfcctioa:OialGil, M.H =hlorite.(.Chlorine)... Driller commems." disclaimers............................................................. .... ........I _ ........... -................................................................ .................................................................................................... 1-'eltdrillernanw;. Seth Company name: .... defty Drillingt Inc. ........................ Maihngaddre��:...3540.Akula Dr .............................................. city: Anchorage State: AK zip 99516 Phone uutnbor: (,_._907 ) 345 _ 0593 Nx:345-4700 DrilluN, signature. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Section 4700 South Brapw St. P -O- Box 196650 Anchorage, AK 99519-6650 www.m un i.ott;/onsite (907)343-7904 Attention: Properly owner shall provide a well DSD within 60 days of well completion. Permit Number: SWO70297 Dare of Issue. Oct/ 30 /20)07 Parcel Idcntificntion:Number: Q75 — 092-70 N well located at approved permit luwtian' (X) Ybs or ( ) log to the No MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Oct 30, 2007 Expiration Date: Oct 29, 2008 Permit Number: SW070297 Parcel ID: 075-092-70 Legal Description: EAGLE ROCK LOT 25C Design Engineer: 0000 ZZ - NONE NEEDED Site Address: NHN WADONIA WAY Owner Name: KRISTIAN & FRED DIELING Lot Size: 16640 SQ. FT. Owner Address: PO BOX 92 Total Bedrooms: 3 Permit Bedrooms: 3 GIRDWOOD , AK 99587 - This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. iCIV1,4W ' we I I r e 10 co,4d ?-W t4tkV stt6km-; ht, Ile 1 Received By: Issued By: Date: 14 14 m' Date: 89ZLO A Municipality of Anchorage :-,Development Services•Depadment if Building Safety Division -j On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 ON-SITE SEPTICIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015- O l Z 7-70 Property owner(s) VR - r7A<y) 51 1-irJLI Day phone ZZ-, - IZ 2 7 - Mailing Mailing address F6 folic 97 61cowcoD M4 Zip Code 1426 Site address \rJAp04IA WA`t Zip Code C1g5$7 Legal description (Sub'd, Block & Lot) f^ RC, L E ROCK L -r '25 C - Legal description (Township, Section & Range) Lot Size (_G 0 Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well A Water Storage ❑ Number of Bedrooms THIS APPLICATION IS AN: Initial Upgrade ❑ Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner of author'izAl agent) PermiVRush Fees: %-73 Waiver Fees: _ Date of Payment: lO j�_q Date of Payment: Receipt Number. Receipt Number: (Rev. 17105) iolmlos Alyeska Hwy SITE PLAN for EAGLE ROCK SUBDIVISION LOT 25C j; Kristian Sieling - Owner 10/8/2008 Scale 1"=50' 4 HLB L d li I -} t well I I manhole I '�- u iise a p . c t pnv to ew O S E t ' rad t rad I I t well 5' rad I I I t a y 0 1 rad I Private . I rl Access I I Easements I utility easement I - o t t - WADONIA t I WAY A s utility easements t I I Alyeska Hwy SITE PLAN for EAGLE ROCK SUBDIVISION LOT 25C j; Kristian Sieling - Owner 10/8/2008 Scale 1"=50' 4 MUNICIPALITY OF ANCHORAGE �r15Pcz__rC Ij0 3 - ansa gWc.q--7g3_aEyS WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE: (907)564.2762 WASTEWATER CONNECT PERMIT 07-5552 DATE OF APPLICATION 07/17/2007 SCHEDULED COMPLETION DATE 12/31/2007 BLOCK/LOT/TRACT LT 25C C SINGLE FAMILY SUBDIVISION EAGLE ROCK ❑ MULTI -DWELLING No. APTS_ n COMMERCIAL TAX CODE 7509270 GRID SE4813 AS -BUILT STREET ADDRESS NHN WADONIA OWNER A PHONE MAIL ADDRESS PO BOX W GIRDWOOD. AK 995870288 CONTRACTOR 'UNKNOWN ASSESSMENTS Repair Existing Service QX Main Line Extension �X On Property Only n CltyTap Have Been Levied Hydrant Only 50' or Longer To Be Levied Main Tap -To Property Line Only Comments: ❑ Main Tap & On Property Connect Row No. Disconnect R & R -Main Tap Only CONNECT SIZE 4 ISSUED w. cm INSPECTION FEE $ 54.00 PAID L] CASH PERMIT FEE $ 48.00 C H E C K # /eDlo� $ 0.00 {tj OTHER DEPOSIT $ 0.00 INSPECTED BY REIMBURSABLE 02.00 TOTAL $�1 NUMBER DATE / / REMARKS PERMITTEE (Please Print) MAIL ADDRESS (�c SIGNATURE (� PHONE 2Z7-17Z2- POST ZT-12Z2 2 POST IN A CONSPICUOUS PLACE AT THE JOB SITE CUSTOMER COPY Original 01/01/2006 00:12 19077830288 COLLINS FLOORING ` dump. Installation Log, UXAYM w�a wtu ABOVE aao.Ko CASW. — -- PAGE 01/01 (� i Pitless AdapterMsaafncturves Nlamet pI V -N FgdmAdapter Installer. TME r "4' S ~ = o „ODES ai 1 b 01 3 SEIMAL R Pww • F 5 cow rVCz Two PVT.^—.�--- I .� CWAVAWn e. tAl Z POWER CASH II PICCmW- I? i Ate.. Cl. Li .IM CAUINk f Fan Q 71"—,:—L MTAKC SVAg;TU C: Tw* To . �1 OPp 110tE_'„_C.�' To well was disinfected upon completion. i method: calcium hypochlorite. DnCRne, Zn n Water Weff and Pump Service gLncharave, 9traska �907) 34S-0593 j 'rt Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 075-092-70 1. GENERAL INFORMATION: Expiration Date: 1 0 — q " Z- ( Complete legal description EAGLE ROCK; LOT 25C Location (site address) 144 Wadonia Way *Girdwood 99587 Current Property owner(s) Jessica Seiling Day phone Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 1 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 2- 8 C7 I Waiver Fee $ _ Date of Payment -7 1 1 10,091 Date of Payment Receipt Number Q 9 18, 6 Receipt Number COSA # 0S C2/ /3 79 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 EastTudorRoad, Suite 101 -Anchorage, Alaska 99507 Engineer' . s Printed Name: Jeffrey A. Garness Date: (2,f In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) 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, with the fol . . .. .. . .. . ... . . . ... .. . ev A. Gcrbess.-' 1.41 C e s #AECC884 N U T Y \4 D s t i p �gWq &I., 4AI, rr7 5^14f Zc 9 1 ts. NN , , 9) 'S" Original Certificate Date: -7-c(,Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 0.210 Y;-X/ .......... . . .. .. . .. . ... . . . ... .. . ev A. Gcrbess.-' 1.41 C e s #AECC884 N U T Y \4 D s t i p �gWq &I., 4AI, rr7 5^14f Zc 9 1 ts. NN , , 9) 'S" Original Certificate Date: -7-c(,Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 0.210 OSA Checklist Legal Description: EAGLE ROCK; LOT 25C Parcel ID: 075-092-70 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA VVell log is filed with Onsite (or attached) Date drilled 10/9/08 Total depth 104 ft Cased to 104 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/13/21 Static water level at beginning of test 82.1 ft. Comments B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION! FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max Measured depth to pipe invert from grade ft ❑ N/A - pressurized field ❑ ivionitor tubes go to bottom o!'effective. If not, st depth into effective Code -required soil c er over field ❑ System preso d (Required if v- nt for greater than 30 days prior t date of to qXns introduced gallons ments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 4.9+ gpm Water storage tank volume NSA gallons WII disinfected for coliform test? F-1Yes [0-1No Coliform bacteria is Ne ative Nitrate mg/LN'trate less than MRL (ND) Arsenic ug/L Vsenic less than URL (ND) Collected by GEG, LTD. Date of Sample 6/13/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments:' Zequacy test date Results ❑]Pass For bedrooms Fluid depth prior to test in (min) Water added gal New depth in ate Elapsed time min Final fluid depth in Absorption rate gpd o Any rejuvenation treatment (past 12 months) If yes, enter date AWWUSEWER ata E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑✓ Yes if No_ Neighboring Tank? 100' ❑� Yes if No ft Private Sewer/Septic Line > 25' ED Yes if No Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' ❑✓ Yes if No _ Neighboring Absorption Fields > 100' Water Service Line > 10' Animal Containment > 50' ❑✓ Yes if No _ ❑✓ Yes if No ft 11,�` Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ❑✓ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required Building Foundations > '10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No • Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: / J Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' Yes if No. o- Water Water Main > •10' ❑ Yes if No ft Community We Is -.-,'200' E]Yes if No Water Service Line > 10' ❑ Yes if No ft q aseptic -t nk is under driveway comment below 11,�` ft ft ft ft ft ft ft From Absorption Field on Lot to: (Please enter distances-ifl"ess than required) Building Foundation > 10' ❑ Yes if N ft If absorption field is under driveway comment below Property Line > 10' P— s if No ft Wells on Adjacent Lots: Water Main > 10' ElYes if No ft Private Wells > 100' F1Yes if No ft Water Sere ine > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft StVacee-W"ater> 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS *NO MANHOLES LOCATED - SEE AWWU CONNECT CARD G. ENGINEER'S CERTIFICATION 1 certifythat 1 have determined through field inspections and review Vl of Municipal records that the above systems are in conformance with G' C �� �?T�,• ' j� �� MOA COSA guidelines in effect on this date. ,� u ; , i,`: j ( .......... COSA Checklist yellow sheet 1 ey A. Gbrness•- Profess+00o a MECC884 nAl PRG>CSE'D P3iMIED FUCA I E'3_ -V. {AM&L'D) ��vi !L;` f wog I Ina M Car., amt 4--b d I—, and ctet 1 hiwrd m ew ertotWt d 0 f Lha T oai c. tte 14—d to the b-1 w :n, t § h F1."J J'NO CCr2'ti�ri1 t / \ aaacvad tYua a:d ¢+tact t CUN IATiON AS-SUIL? `\''/r�`7\tJ� L 7ot+lr! F_ 3 lnv..tr.. hvaCy Cwury c`.at I -a, Fi<YIf t3JtDpie'iETBAG: I . ( f>+a•• H. > . >,.,+ 2;.h`1n'.: d 11 imat,-to Ce Shea„ homed, ' t d :la MO4C.P'1h81te 6• sC '. �iUl [C.. + A ..; .MSI ;at.Ca >to+n cd,aresA j G' �� •A � FINAl. SmUCTURE AS -BUILT •• s > I, .: +;t a lima, S, hwtby twtHy Chat ! l.,r. a.WtYmW m Ae-TA�3t •rw/ of t+a p�f` }, �( aw `legg �t-1••+'`'>.> "' ,.>''•• ?' .!; hN_ M t.hta !dt a d Ciat M Lha ix•»i::ata :;r,d Wtrnrd k. as eho hwe cra rv. xd as int Ix2ea '�i`A Cf ••••, ••>•> T(� '�'• `Y 'fir J // '•.'�-... ` meq; �� ., �` \ 4 2 O ♦ \ / . LOT =5 a % \ LOT ?i D . \ \ \ '9Cj � r• 6 \ I \\ LOT 25.4 hP \ \ i Y \ rI r r i UNDER NO CIRCUMSTANCES SHOULD AN AS-BU!LT BE USED PCR CONSTRUCTION OR F'OR cSTASLIISH;SG BOUNDARY OR rukCF LINES. THE SURVEYOR "TAKES RESPONSIBIUTY FOR THE ENM'AL nA IS;C70,N ONLY AND ASSUMES FiNA.NCIAL LIABILITY 04NLY FGR THE COST OF THE SURVEY _ LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ER2ORS III SCALE. i ccT SJRVEY SUR.'EY Type- ( Y S MSOLS ! ! FCiJNnA PU4 AC-EUM I xra!o I i ° SEREBARINAL DRAINAGE :S— ASPnALT LJ PLOT PLAN . . . AS -ZIP HLT . .LOT SUr't•.£Y .. TCGCh:RP?HFOUND REOAR Y 1 �"'�= YilOD FENCE �� CONCRE i= I !i� 'S-'L1i:ILi NO CC1eZN� }.T _I 9ECERTLRCA_,1CN AS-SVILT ... NO CCRti%?5 ^ET ASSUMED LLE V. —i- - };{=,TEAL FtNCE f A� e-•: 100E DECK I =LOT PLANS & LOT SURVEYS ; ;COTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS .AND TO DE TI=RM!NF THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTPONS RICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CERTIFICATION 1 PLOT PLAN I '- by d V!y .hut I haw N,,�casy —,,,d�r............ ��vi !L;` f wog I Ina M Car., amt 4--b d I—, and ctet 1 hiwrd m ew ertotWt d 0 f Lha T oai c. tte 14—d to the b-1 w :n, 4— /� f "1AV ,•` > / '• Y.1'+dacy'^e 0.'!d Mj: a7 Gm�w+oK.ia Ww ?sm _. • aaacvad tYua a:d ¢+tact AT Y' t • CUN IATiON AS-SUIL? J lt6 '` �+„ "� • �s�,. 'et.' L 7ot+lr! F_ 3 lnv..tr.. hvaCy Cwury c`.at I -a, how pctsrrctal c, Aa -Mt wrwy al tta RaAm a, tf>Y Tai _d that W the . ( f>+a•• H. > . >,.,+ 2;.h`1n'.: d 11 imat,-to Ce Shea„ homed, ' t d :la MO4C.P'1h81te 6• sC '. �iUl [C.. + A ..; .MSI ;at.Ca >to+n cd,aresA j G' �� •A � FINAl. SmUCTURE AS -BUILT •• s > I, .: +;t a lima, S, hwtby twtHy Chat ! l.,r. a.WtYmW m Ae-TA�3t •rw/ of t+a p�f` }, �( aw `legg �t-1••+'`'>.> "' ,.>''•• ?' .!; hN_ M t.hta !dt a d Ciat M Lha ix•»i::ata :;r,d Wtrnrd k. as eho hwe cra rv. xd as int Ix2ea '�i`A Cf ••••, ••>•> T(� '�'• `Y 'fir J ONLY THOSE MI..PROVE RENTS ABOVE. GROUND AND VISIBLE WLL BE SHOVYN. FENCES. WELLS, S= ?TIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOI&W its, THEIR APPROX;IJA E: LOCATION. ONLY. SNOW MAY PREVENT SOME IPAPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERVASE NOTED. Prepared by Robert- F. Jo ins, Jr. & Assoc;. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 Scolc: V1 _ ^00' 'Rec 0''Rec- !Root S.F. IRec. Plat Fila Na. 3etc Survaynd: A l J t tDrew„ Dy, p ! Checked b �3 4; 78I !� 1 Q REJ ��fAIi �eie Dre sn: 4/118/12 ,� 1 G-8 r Clea: D•isCriF tiC^: EAGLE ROCK LOT ?5C: MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE:(907)564-2762 BLOCK/LOT/TRACT: LT 25C / SUBDIVISION: EAGLE ROCK TAX CODE: 07509270000 GRID: SE4813 STREET ADDRESS: 144 WADONIA WAY Girdwood, AK 99587 OWNER: SIELING KRISTIAN W 50% & SIELING FRED H 50% NIAIL ADDRESS: PO BOX 92 GIRDWOOD, AK 995870092 WASTEWATER CONNECT PERMIT 21 DATE OF APPLICATION: 06/0312009 SCHEDULED COMPLETION DATE: 12/31/2009 RX SINGLE FAMILY ❑ MULTI -DWELLING No. APTS 1 ❑ COMMERCIAL PHONE: CONTRACTOR ASSESSMENTS Repair Existing Service ❑ Main Line Extension On Property Only ❑ City Tap X❑ Have Been Levied ❑ Hydrant Only ❑ To Be Levied ❑ Main Tap - To Property Line Only Comments: XJ Main Tap & On Property Connect Row No. ❑ Disconnect > ❑ R & R - Main Tap Only caner I Staff r / ' CONNECT SIZE 4 in ISSUED WWMSR INSPECTION FEE $ 98.00 R PAID ❑ CASH PERMIT FEE $ 3.00 ❑ CHECK # $ 0.00 Q OTHER DEPOSIT S 0.00 REIMBURSABLE INSPECTED BY f—'r..,? NUMBER TOTAL $ 161.00 DATE If t-( O cj REMARKS P—IMITEE (Please Print) SIELING KRISTIAN W 50% & SIELING FRED H 500/cPHONE Mi,iL ADDRESS PO BOX 92 GIRDWOOD, AK 995870092 SIGNATURE POST IN A CONSPICUOUS PLACE AT THE JOB SITE INSPECTOR COPY DATE SCHEDULED '12/3'1/2009 TIME 12:00 am INSPECTOR f�_rej ��o SUBDIVISION EAGLE ROCK BLOCK/LOT/TRACT LT 25C / INDICATE NORTH 1 /h H1ly— �a in5v�5t.�,d _�_ e� L,N cormmj .. 5cruis Ser'vt 4 � 1 _ I C O I: li i � 1! Si ! e � E a SIZE MAIN: 1. TYPE MAIN: DEPTH AT MAIN:) TPROP. LINE: CONNECT LOCATION: COMMENTS: INSEPECTED BY: DATE F r 1. If a�J TIFR�