HomeMy WebLinkAboutSHANE LEE ESTATES BLK 1 LT 3Shane Lee
Estates
Block 1
Lot 3
#014-061-59
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DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 y`�� STF�EET. HNCHORHGE/ HK99^�g1
� ^ 279-2511
PERM! I- NO. ( 77179 >
HPPLICHNT EDWIN RIMIER 8]10 WELLSLEY CT ]44~4131
LOCHTION
LEGHL L3 B1 SHANE—LEE ESTHTES LOT SIZE 8000 SQUARE. FEET
MINIMUM DISTANCE BETWEEN 0 WELL AND ANY ON—SITE SEWHGE DISPQSHL SYSTEM IS
100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC: WELL
WELL LOGS ARE REQUIRED AND MUST BE RETURNED Ti.",) THE DEPARTMENT WITHIN ]0 DA'Y'S
OF THE WELL COMPLETION.
SPECIFICHTIONS
AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
������� ����� ��� ��� ���� ���� ����I FE
-
EE
CERTlFY THAT
1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2� I WILL INSTHLL THE S M IN ACCORDANCE WITH THE CODES�
�
SIGNED:~~------
APPLICANT
~HPPLICHNT EDWIN RINNER
�
•
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�GL BG
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• Municipality of Anchorage =�
On-Site Water and Wastewater Program K
(907) 343-7904 5 d i T Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 014-061-59 Expiration Date: 7— so-JO
1. GENERAL INFORMATION
Complete legal description SHANE LEE ESTATES BLOCK 1, LOT 3
Location (site address) 6730 TIFFANY TERRACE,ANCHORAGE, AK 99507
Current Property owner(s) CHRISTOPHER M. &CAITLIN E. RELJIN Day phone
Mailing address 6730 TIFFANY TERRACE,ANCHORAGE,AK 99507
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: 3
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: Distance:
/cK
Received by: �� //I
''�, Date: 7/.
COSA to be released to the engineer,unless othe ill::req ested by the engineer.
COSA Fee $ a5 i1 Waiver Fee $
Date of Payment 5V0 Date of Payment
Receipt Number Q 5.a)-D Receipt Number
COSA# O C/Cg 1 U9-1 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 ARCTERRA CONSULTING,INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 4/23/2018
Engineer's Comments:This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The 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 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 function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen 411' OF A
encroachments,deficiencies or discrepancies exist. <S, L
s *�4• T11*
6. DSD SIGNATURE kg I Ix'1.7
System #1 Approved for bedrooms. KENNETH " i�
System #2 Approved for bedrooms. k o P. ,z -
Disapproved. \\ o���
Conditional approval for bedrooms, with the following stipulations:
OF All/c
'0
4
ON-SITE TN1
•
W PROGRAM ••
cam'
4/;Pk17 q1:7D0\C
EaFr Air Original Certificate Date: LL 30
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 X Nitrate Advisory
•
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10.12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: SHANE LEE ESTATES BLOCK 1, LOT 3 _ Parcel ID: 014-061-59
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID#_ Well Log (Y/N)Y
Date completed 111911978 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth 65 ft. Cased to 65 ft. Casing height(above ground) 24+ in.
FROM WELL LOG AT INSPECTION
Date of test 1/19/1978 _ _ 412012018
Static water level 21 ft. 19 ft.
Well production 15 g.p.m. 3+ g.p.m.
WATER SAMPLE RESULTS: tp-�
Coliform NEG colonies/100 mL Nitrate ��r f mg/L
Arsenic: ND ug/L Date of sample: 4/20/2018 Collected by: ARCTERRA
B. SEPTIC/HOLDING TANK DATA—PUBLIC SEWER
Tank Type/MaterialDate installed
Tank size gal. Number of Compartments Cleanouts(Y/N)
Foundation cleanout(Y/N) Depression over tank(Y/N) High water alarm (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth_in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access(YIN)
"Pump on" level at_in. "Pump off' level at_in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot NA On adjacent lots NA
Absorption field on lot NA On adjacent lots NA
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank NA
Animal containment areas 50'+ Manure/animal excrete storage areas 1001+
SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO: PUBLIC SEWER
Property line Building foundation Water main
Water Service line Surface water Driveway, parking/vehicle storage
Curtain drain Wells on adjacent lots
F. COMMENTS
.Ar - OFA4
G. ENGINEER'S CERTIFICATION � 9 `
•
4111
I certify that I have determined through field inspections and review of WATA'
Municipal records that the above systems are in conformance with MOA
hENNF.TH M. a.
COSA guidelines in effect on this date. 7 6
Engineer's Printed Name KENNETH M.DUFFUS l(titssicf: -or
�
Date 04/23/2018
COSA canary sheet_2-6-15.doc
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 014-061-59
1. GENERAL INFORMATION
Expiration Date: C -Z 1 - / '-/
Complete legal description SHANE LEE ESTATES BLOCK 1, LOT 3
Location (site address) 6730 TIFFANY TERRACE, ANCHORAGE, AK 99507
Current Property owner(s) GREGORY & JESSICA DORRINGTON Day phone
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
6730 TIFFANY TERRACE, ANCHORAGE AK 99507
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class _ Well
Public Water System
WaiverNariance request for:
3
Day phone
l IU�f Ak
MAY 1 6 2014 L
TYPE OF WASTEWATER DISPOSAL:
Received b ,' ""
Y� � "-��' Date: •5�2-1-rtl'
COSA to be released td_ihe,engineer, unless otherwise requested by the engineer.
COSA Fee $ 52__(0 _
Date of Payment
Receipt Number 0�5� 11
COSA# 055-14"15
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
nce:
Individual
❑
®
Holding Tank
❑
❑
Community
❑
❑
Public Sewer
El
Received b ,' ""
Y� � "-��' Date: •5�2-1-rtl'
COSA to be released td_ihe,engineer, unless otherwise requested by the engineer.
COSA Fee $ 52__(0 _
Date of Payment
Receipt Number 0�5� 11
COSA# 055-14"15
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
nce:
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 ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 5/16/14
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The 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 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 function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen i , OF 11 ALS
encroachments, deficiencies or discrepancies exist.
49TH
6. DSD SIGNATURE
System #1 Approved for bedrooms. i, `"" 71's D F ,\
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
��i�;uuttr
OF An
`= ON-SITE
d
Z WATER A'
o STEWA
J
PROGR)
I�JII��/VT CFR\
TER
By: Original Certificate Date:
Th uniciy A orage 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
COSA blue sheet 10-10-12d.
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: SHANE LEE ESTATES BLOCK 1 LOT 3 Parcel ID: 014.061.59
A. WELL DATA
Well type PRYT If A, B, or C provide PWSID #
Date completed 111911978 Sanitary seal (Y/N) Y
Total depth 65 ft. Cased to 65 ft.
FROM WELL LOG
Date of test 1/1911978
Static water level 21 ft.
Well production 15 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic: ND ug/L Date of sample: W/2014
B. SEPTIC/HOLDING TANK DATA — PUBLIC SEWER
Tank Type/Material
Tank size _ gal. Number of Compartments
Foundation cleanout (Y/N) Depression over tank (Y/N)
Date of pumping
Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2 or ftZ/bdrm)
Length ft. Width ft.
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24+ in.
AT INSPECTION
517/2014
ft.
g.p.m.
Collected by: ARCTERRA
Date installed
Cleanouts(Y/N)
High water alarm (YIN)
System type
Gravel below pipe
Total depth ft. Eff. absorption area ftZ Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail)
Fluid depth in absorption field before test _ in.
Elapsed Time: _min. Final fluid depth _ in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) _
Water added al.
Absorption rate >=
i#
For bedrooms
New depth_ in.
If yes, give date
.M.
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 tank/lift station on lot NA
Absorption field on lot NA
Publicsewermain 751+
Sewer /septic service line 25'+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation
Property line
Water main
Water service line
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO: PUBLIC SEWER
Property line
Building foundation
Water Service line
Surface water
Curtain drain
Wells on adjacent lots _
F. COMMENTS
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots NA
On adjacent lots NA
Public sewer manhole/cleanout 100'+
Holding tank NA
Manure/animal excrete storage areas 1004
Absorption fiel
Surface water
Water main
Driveway, parking/vehicle storage
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
COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 05116/2014
COSA brown sheet 10-10-12.doc
in.
r4c)
OF AL*TH- �,� �,
V P KENNETH M_
T T116 l�� /
6 /G
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my Investigation,
based on procedures outlined in the Certificate of Onsite Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Finn
Anderson Engineering Phone 522-7773
Address P.O. Boz 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
Approved for _ bedrooms.
Disapproved.
Date 2/13=09
�gw��tv�t+��
�..,,OF A4 14
P.!
WCHAEL E. ANDERSON
CE -4381
�• •Zit-0,,:�y.�.`
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: y�iin/ Original Certificate Date,
mw. nasi
Municipality of Anchorage
Development Services Department `=
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 3, Block 1, Shane Lee Estates Subdivision Parcel ID.- 014-061-59
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _ Well Log (YIN) Y
Date completed IM978 Sanitary seal (YIN) Y Wires properly protected (YRJ) Y
Total depth 65 It Caiad to 65 fL Caiimg�a ght{abOYagroumd) "rt In,
FROM WELL LOG AT INSPECTION
Date of lest 1/19(78 2/8/09
Static water level 21 ft. 27 fL
Well production 1s g.p.m. 9.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate NN mg1L Other bacteria 0 colonies/100 mL
Arsenic wD ugA Date of sample: 219109 Collected by: MEA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Date Installed
--- _-__Tank size- gal. --_._Number of Compartments_--- - (YIN) ---
-Cteanouts ------ -...
Foundation cleanout (YIN) _ Depression over tank (Y/N) _ High water alarm'(Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.dJft2 or ft2/bdrm) T_ System type
Length fL Width ft. Gravel below pipe ft.
Total depth fL Eff. absorption area —ft" Monftoring tube Depression over field _
Date of adequacy test Results (PaswFail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth In. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N)
'Pump on' level at _In. 'Pump off level at_
In. High water alarm level at in.
Datum Cycles tested
Meets alarm 8 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
On adjacent lots
Absorption field on lot
On adjacent lots
Public sewer main 85""'
Public sewer manhole/cleanout 83"
Sewer/septic service line '
Holding tank NIA
Animal containment areas None
Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation Property line _
Absorption field
Water main Water service line
Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation
Water main
Water Service line Surfacewater
Driveway. parking/vehlcie storage
Curtain drain Wells on adjacent lots
F. COMMENTS: Lot Is served by AW WU Sewer System. Well was constructed in 1978. Separation distances to Community Sewer
Mains and Manholes were not established at that time.
G. ENGINEER'S CERTIFICATION dw�P0SW
I certify that I have determined through field inspections and 67'.*
a9� V . •� ��
«.
review of Municipal records that the above systems are in /' ..... ...... ([/
conformance with MOA COSA guidelines In effect on this date. • . ••"".4
I .o : i+t6GHnii E' l�rlorxsor+:... �.
Engineer's Printed Name Michael E. Anderson. P.E. �� �'•; 71
Date 7122/2008 d�,1��� Ro ESS o tea` j
s
COSA Fee $ 0 Waiver Fee $
Date of Payment 2 '� Date of Payment
Receipt Number 173386 Receipt Number
(Rev. 11105)
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-� MUNICIPALITY OF ANCHORAGE
®A DEPARTME OF HEALTH AND ENVIRONMENT PROTECTION
825'- L Street, Anchoraaa. Alaska 99501
264-4720
Date Received: January 26, 1978
#1: Time �);,3�Anj #2: Time #3: Time
Date Q- /1„-7g C / kt.L4S Date Date
Insp Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
% Kitty Phillips
1. Lending Institution Request: First National Bank of Anchorage
Mailing Address: Post Office Box 720 99
Phone: 276-6300/490
2. Property Owner: Larry Sebring Phone: 344=3069
Mailing Address: 6730 Teffany Terrace
3. Legal Description: Lot 3 Block 1 Shane Lee Estates Subdivision
4: Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms: Two
Number of Bedrooms:
5. Well System: Individual Well (x) Community/Public System ( )
Permit # Depth(` of Well &C fWell Log on File./
Construction�Bacterial Analysis act
6. Sewage Disposal System: On-site System ( ) Public Utility (x)
Permit #
Septic Tank Size
Absorption Area
Installed
Installer
Manufacturer
Soils Rate
7. Distances: Well to Septic Tank
to Sewer Line
to Nearest Lot Line
Nearest Lot line
Material
to Absorption Area
Absorption Area
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 3 Block 1 Shane Lee Estates Subdivision
Comments:
Affadavit Attached:— ( ) Letter Attached: ( )
Approved: 1\ C Date:
Disapproved: Date:
Department Worksheet:
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6. Legal Description: Lot 3 Block 1 Shane Lee Estates
Location: 6730 Tiffany Terrace
Anchorage, Alaska
7. Type of Facility to be inspected: Single Family Residence No. Bdrms. 2
8. Water Supply
Type of Supply: Public Utility Individual X
If Individual, number of dwellings presently served
9
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
LU -031(1 N
X Individual (onsite)
Kitty Phi113�s 1/24 R8"
I � 'i
MUNICIPALITY OF ANCHORAGE
!'
,
`
_PARTMENT OF ENVIRONMENTAL QUALi. Y
825 L Street, Anchorage, Alaska 99501
279-2511, ext 224,225.
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1.
Type of ,Inspection: CMRO VA FHA
CONV X
2.
Property Owner: Larry Sebring
Mailing Address: 6730 Tiffany Terrace • Anchorage Day Phone
344-3069
3.
Name of Buyer: Arthur E. & Mary P. Sortore
Mailing Address: 3905 Dunsmere Court Anchorage, Ak. Day Phone
276-6300 EXT 620
Bank Anchorage
vx—�I-LRS
4.
Name of Lending Institution: First National of u ,
;
Mailing Address: P.O. Box 720 Anchorage, Alaska Phone 276-6300 EXT 490
5.
Name of Realtor or Agent: Will Hepburn
Mailing Address: 2700 East Tudor Anchorage, Ak. Phone 276-2400
6. Legal Description: Lot 3 Block 1 Shane Lee Estates
Location: 6730 Tiffany Terrace
Anchorage, Alaska
7. Type of Facility to be inspected: Single Family Residence No. Bdrms. 2
8. Water Supply
Type of Supply: Public Utility Individual X
If Individual, number of dwellings presently served
9
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
LU -031(1 N
X Individual (onsite)
Kitty Phi113�s 1/24 R8"
I � 'i