HomeMy WebLinkAboutUS SURVEY 3044 LT 36A T10N R2E SEC 17
Permit ~
~pplicant:
Location
7_~UNICIPALITY OF ANCHORAGE
Department' , Health and Environmental rotection
825 ~. Street, Anchorage, AK. ~'501
264-4720
* * * HANDWRITTEN PERMIT * *
WELL ~ PERMIT
Legal Description: ~ ~ 9~r7 £D/"] ~' Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed': __ Holding Tank:
Maximum Number of Bedrooms:~ . Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System is:
DEPTH ~-----'LENGTH ~ GRAVEL DEPTH ~_. WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground 9nd
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = ,//x/~, GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will'serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departmeni
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee~
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction"diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 3L 1 9 * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install~ ~h~stem in accordance with codes.
(3) ~/nderst/~ ~. ~ th~ on-site sewer system may r~uire enlargement if
~/~es::::~ r?:odeled to include more~bedrooms.
Applicant~ ' Date:
SWP/024(1/81)
' ~1-VV DRILLING, Inc.
P.O. Box 10-378 · 10300 OJd Seward Highway
~r (907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner MIKE OUEEN Use of Well
Location (address o/: Township, Range, Section, if known; or distance main road Lnt 36A Saction 17 T10N ~.2E Seward Meridian
Domestic
Size of casing 6" Depth of Hole 60 feet Cased to 60.7 feet
Static water level 4] ft. (aT~o.v~) (below) land surface. Finish of well (check one)
Screen ( ); Perforated ( ).
Describe screen or perforation N~n~
Well pumping test at 5 gallons per of drawdown from static level.
Date of completion (~c~ober 31, 198~
openend (~x );
(minute) for ~ hours with ! 00% ;(t~
WELL LOG :
Depth in feet from
ground surface Give details of formations penetrated, size of mhterial,, color and hardness
0 TO 2 Casing atickup
2 3
TO_
3 TO_ 5
5 TO 10
10 TO 55
55 TO 6~
TO
TO
TO
TO
.TO
_TO.
_TO.
.TO.
9ack, ill
Organics
Gravelly coarse sand
Gravel
~aterbearing gravel
3--CONTRACTOR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include Jot, block, subdivision, section, township, range)
Location (address or directions)
(b) Apphcant Name ~/c~ J~¢~(~ Telephone~ ~ome ~,~ ~ - Business
(c) Applicant is (check one): Lending Institution ~; Ownsr/builder~ Buyer ~; Other ~ (explain);
(e)
Lend,ng Institution
Address
Telephone
Real Estate Company and Agent
Address
(f)
Telephone
Mail th%HAA to the following address:
TYPE OF RESIDENCE
Single-Family [] Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If corn m unity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE, D~ '"~
Onsite [] CPublic ~] C~mmunity [~ Holding Tank []
core--stem must have written confirmation from the State Department of Environ mental Conservation
Note:
if
attesting to the legality and status,
72 025 (11184)
Page 1 of 2
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 Mueicipality of Anchorage flies 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.
NameofFirm ~'~'c~'~:~f 'J~"~////~,¢c;[ ~,~ ~Telephone ~//~
Address l ~ ~ ~. / ~c~/~ ~1~ ~1d
Engineer's Seal
DHEP APPROV~/I~
Terms of Conditional Approval
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 ol Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
NORTHERN TESTING LABORATORIES, INC.
600 UNIVERSITY pLAZA WEST, SUITE A FAIRBANKS, ALASKA 99701 907-479-3115
6957 OLD SEWARD HIGHWAY, SUITE 101 ANCHORAGE, ALASKA 99502 909-349-8623
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
PRIVATE WATER SYSTEM
Zip Code
NAME
City State
SAMPLE DATE: ~ ~/ ~-,~ Phone 3q~-' ~ (3S-5~
MO. Day Year
Purchase Order No.
[] Treated Water
[] Untreated Water
)
SAMPLE TYPE:
r~ Routine
[] Special Purpose
[] Check Sample (for original contaminated
sample with lab reference no.
ample Time
NO. Location Collected Collected by
2
9
10
Signature of Representative
FOR LABORATORY USE ONLY
TO BE COMPLETED BY LABORATORY
Received at: I~ Anch. [] Fbks.
Time Received / (~ O~
Next Sample Due
COMMENTS:
SATISFACTORY (~
UNSATISFACTORY U
RESAMPLE R
OTHER BACTERIA OB
TOO NUMEROUS TNTC
TO COUNT
)lrect VetiScation Final
Count LSB BGB Result*
4
J
Date
Time
~ . APPLiC,~"~]T FILLS OUT UPPER HAL?~DNLY
P~,.;p~ertyOw~er ~,¥1\C.[t~(:.J~ ~, C~)~.~S-/-~ / ~ ~ J~. ~l~l-~- Phone
MailingA~dre~ j:~, ~'1 ~ J~Lg~(2~I /~ ZipCode ~g~ ~-~)'~
.~ I~'A~ Zip Code
Lending InsStution ~ (~ C ~ [ i~ l %,.~ i~ ~ ~ ~/) PJ ~ ~ ~ ~ ~ Phone
Address ~J / ~ Zip Code
Legal Description ~T ~ ~ ~J 0 ~ R2E Section 17
Street Looalim j~ j_~ C ~ ~ ~
Time Time Time Time
Date, ~'~
Date Date Date
Insp tot
Inspector Inspe:;tor Insp~tor
Field Notes:
~4.
"~'~P~'R~VED SEDROOMS 'CONDITIONS OF APPROVAL
( } DISAPPROVED
I ~ ~ON~T~ONAL APPROVAL'
DATE '~"'~ (
BY: ~
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 {3182)
January Bit, 19U4
~lichael ,~0 t)ueen
Susan (,I. Riehle
P. O. [~)ox 647
Girdwood, Alaska 99587
Subject." Lot 36A, TION, ~i2E, Sectio~ 17
Approval for the individual sewer end water facilities cannot
be granted until the following items have been completed:
o Our records indicate that your well was drilled v;ithout a
· zpermit. You may obtain a permit from this office, Department
~/~jof Health a..nd Environmental Protection, g25 L Street,
26z~-4'721.
The well-outbouse sepa%'tion is not adequate. There needs to
~/~be 100' horizontal s~paration. The distance now is 80 feet.
These items must be corrected before a Heattl% Authority
approval can be grar~tedo
You are in violation o~ HOA ordinance i5,5b0~)30o
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 2G4-~7200
Sincerely,
a3{24/ej/E1
cc: B° J. Rogers
Securit~ National
Attachment: 15.55
Bank
Jim Roberts
Associate Environmental Specialist .,
MUNICIPALITY OF /ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 075-061-73
Certificate of On -Site Systems Approval
Expiration Date:
Legal description US SURVEY 3044 LT 36A T1 ON R2E SEC 17
Site address 1877 ALYESKA HWY
Current property owner(s) TITONE REBECCA R
6/24/23
X The On-site system(s) is/are approved for 2 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: Original Certificate Date: 3/24/23
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 ApprovaLJune 2022
MUNMPAUTY 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
Parcel I.D. 075-061-73
Complete legal description US Survey 3044 Lot 36A T10N R2 Section 17
Location (site address) 1877 Alyeska Hwy
Current property owner(s) Rebecca Rogers Day phone (907) 317-6554
2. ON-SITE SYSTEMS SIZED FOR 2 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•t
uS.tcd U nl
Age - See advisory if steel older than 20 years
!_— ABSORPTION -FD: E AAWwWT-S [3 Bed H Diti:�:�otii►eiEl civ►:e -Fen:iiR S1K:�'�'►=►:Pt
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 $ 2- 8 22
Date of Payment
COSA #
Waiver Fee $
Date of Payment
Waiver #
COSA Application -June 2022
US Survey 3044 Lot 36A T10N R2E Section 17 075-061-73
5.8
10/31/83 60
60
0.518
24+
3/13/23 Forge Engineering
45.7 3/13/23
>
Benjamin Schiller, P.E.3/14/23
N/A
N/A
N/A
N/A
N/A N/A
N/A
N/A N/A
N/A N/A
N/A
(907) 522-7773
Snyder
Subdivision
Lot
2
0 25 50
US SURVEY
FEET
NCITFC /
65
S ce �
]Lot �
3,6A\
6 \\
F Sed
\ W 2 -Story
House
Lot
36C
oar_
t1�
i9
Lot
36D
i
i
1
OF
Jere A rs
�� F�,•, -1 7 ,•i /�
• S
ll; FESSIOVA �'�`•�
5-
_ oar Lot \ 9�'9��\ / Sir air
}' r6 368
Y / \
(0- �\
-All dimensions shown are grid bearings and ground distances, record boundaries are per No. 82-296
-49th Star has conducted a physical survey of the property and all details shown on this Asbuilt Survey are correct. Under no
circumstances should any data hereon be used for construction or the establishment of property lines.
-Only those easements from the record plat are shown.. It is the owner's responsibility to determine the existence of any other
easements, covenants, or restrictions; no title research performed.
-Plat 82-296 contains the following note: "Both Lots 36A and 36B share one common driveway onto Alyeska Highway."
AS BUILT SURVEY
Lot 36A
US Survey No. 30449
Girdwood, AK
T _FGFNI)
O Well
Utility Pole
49th Star Surveying I 1-f
PO Box 738
Girdwood, AK 99587-0738
(907)891-6111
Jeremy@49thStarSurveying.com
W.O. 2307 I DATE: 3/18/23
SCALE: 1"=50'
TAX CODE No. 01 S c,(a i % F. C1�tl- ; E{ GRID No. -7 (oL�
MUNICIPALITY
OF ANCHORAGE —
SEWER UTILITY
PROPERTY
Name i.! C Vna..d C (icrt
Address
!'
4`7 Acct.No_7�-c""c2,CC
Plat No. Subd.
3,
Lot 3 6 ti Block '—
Residential fl Commerial ❑
Industrial ❑ No. of units
CONNECT:
Main Tap ❑ On Property
Permit
No. .3 g� ��i
; --
Size �i Type
Drawing No.. ' — Size Main'-,
Type -Depth at Connect
Insulation ❑ Cleanouts
Type
Connect Agent__
_
Inspector `- r''�
/'%7 i/:/' Date
Comments LOT �iio QtUIDEL
,, j'A1Z[F(S
3 L Lo L.A
Vic _ LA P TO o r., PQnP
! •;;F.Ky� C( hic
T
Connect Location
ASSESSMENTS=
L.I.D. No. Private Dev. No.
Subd. Agreement ❑
No.
Sewer Agreement ❑ No.
RTE. ❑ Roll No.
DYE TEST:
Positive ❑ Negative ❑
N.S.A.
❑ Date
Page No. M.H. No.
Billing Cycle
Tested By
Comments
I A:71
F s4uawwo0
a^, y
a
O
~
\1
L
t
i
>
Z
A371b
133i�1S
t
v
9104UDw j0a4u00 ;o
U014DOO-1 M04S
43191S A8 u01¢oOo-1 aui-1
aOinaaS „Ai83dO8d NO,,
MUNICIPALITY OF ANCHORAGE (MOA)
MUNiCIPALiTy ~q~o~OI~TY APPROVAL (HAAi
DEPT, OF
ENVIRONMENTAL p~7~ -- FEBRUARY 1984
W~LL DATA
Well Classificati
Well Log P~esent (Y/N)
If A, B, c~ C, D.E.C. Approved(Y/N)
Date Completed ~.~/~ /~ Yield
Total Depth ~/' Cased to
Static Water Level
Casing Height Above Ground
Elect=ical Wiring in Conduit (Y/N)
Separation Distances f~c~ Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~
Pump Set At
Depth of G~outing
R,~.
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots N,/~.
; On Adjoining Lots ~,/~.
To Nearest Public Sewer
C leanout/Manhole ~ ~ 7
Water Sample Collected By
Water Sample Test Results
To Nearest Sewer Service Line on LOt
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed Size
Standpipes (Y/N) Air-tight Caps (Y/N)
Depression over Tank (Y/N) Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ;
No. of C~a~tments
Foundation Cleanout (Y/N)
for
Holding Tank High-Wate~ Llama (Y/N) Tempora_~y Holding Tank Permit (Y/N)
Separation Distances f~cm Septic/Holding Tank:
To Water-Supply Well To Building Foundation
To P~operty Line To Disposal Field
To Water Mg~n/~ervi~'"~i'ne~'~'..~ ...... To~, Pond, Lake, c~ Major Drainage
Course~- - >~
/
Re c_~e
~--_ . ~-D~e Paid.
~~~ ~ / ~ ~ Amount..
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils ~ating in Absorption Strata
Date .Installed
Width of Field
Square Feet of Absorption A~ea
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes P~esent (Y/N)
Date of Last Adequacy Test
Separation Distance f~om Absorption Field:
To ~atsr-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To P~operty Line
To Existing oF Abandoned System cn
; On Adjoining Lots
To Cutbank(if present)
To Stream/Pond/Lake/c~ Major D~ainage Course
TO D~iveway, Parkin~ A~ea, o~ Vehicle Storage A~ea
Co~ents ~.0.~, ¢~?~/
D. LIFT STATION
Date Installed
Size in Gallons
"Pum~ On" Level at
High ~ter Alarm Level at
Tested for
Electmical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Counts
** Check Permitted Bedroom Rating Against HAA Request **
certify that I have checked, verified, or conforr~ed to all MOA HAA Guidelines in effect
on the date of this i~specti~n.
Signed
KB1/d5/s
Date
MOA No.
[Page 2 of 2]