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HomeMy WebLinkAboutLot 17Bs-ooTH REE K twoo4c T r7t� b �4- CAM ABEL L. S� K s Q C3 0 UI/ Id 89� 53'UO"v�/ 06.35' "AS - BUILT" Scale 1" _ a I® I hereby certify that a survey of the following described property z,, - was made on 'a�N �a a ' Lz � px>r�o�veemTentAssituated thereo zwryint Ts overly or encroach on the property lines and do .not P property lying adjacent thereto that no improvements on property lying adjacent thereto ��°"•'•�°'`' encroach on the premises in question and that there Are no v�at °��•• roadways,.transmission lines or other visible easements on said property except as indicated hereon. ®1. �... Dated at Anchorage, Alaska, This i day of %4) i �� d ' Z • •• •�� s�: ® ^ . Donald O, Saur _ , �� .• NO. 22336 ,. Donald 0• Saur. J �e 0 .• v Land Surveyor r O �D9•��•....LN'O•O�'J" CONTRACTING ENGIlYSERS & ASSOCIATES 4' 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 4/1 / y /e(> 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lo-' 11/3 CA/KP 13 e4 t- H t� 1 G 1-1 T:5� Location (address or directions) _ (080,9 SPP. UGCt'?OA7 (b) Applicant Name C -A IQE S'S Telephone: Home �i =57) '� Business �3 45 _. 171,;) - Applicant 71.EApplicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderBuyer ❑ ; Other ❑ (explain); - (d) Lending Institution A)/A Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: T'ctil,It?st�r_a ��GirUG7��fNL-, ..- 44o s GAJ I - A &)C t( AK 0147! 7 3 2. TYPE OF RESIDENCE Single -Family E Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well u e"'Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ❑ Public Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (1184) Page 1 of 2 I 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION [.1 As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm SEN f +IJ c U L-A "— 61 )OOt' 1 tif, Telephone 5-6 Address 44'0 W `el--)Sa A3 `3L Date !21 4 e ®,�`�,• � � z t l t `a� .mac '4*, �,Ijy'[��eeeeee°°° °°• _ °• ,• Engineer's Seal e eiY, •ems e A D. WA 11 ERS N e a ®�'� •, E-4483 a`spp . �qi 67 �p©©p®jess U® ®� DHEP APPROVAL^ LC! c? 22 - J� Approved for b U -bedrooms by Date Approved % Disapprov Conditional Terms of Conditional Approval Chep 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) NICtPALITY Of ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MO ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) APR 22" CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: �U'3D A. WELL DATA Well Classification P P.l V AT6 If A, B, C, D.E.C. Approved (Y/N) Iv/p' Well Log Present(Y/N)) )V 1..q� 6 Date Completed 77Yield s� Y/�, T Total Depth �Cased to /!5_0 Depth of Grouting of"jE Static Water Level � C Pump Set At _-57� * Casing Height Above Ground I ff Sanitary Seal on Casing (Y/N) 2rt V Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depression Around Wellhead (Y/N) AJ To Septic/Holding Tank on Lot A)A ; On Adjoining Lots /00 t -/_ To Nearest Edge of Absorption Field on Lot On Adjoining Lots ' Vo ac/:�5 To Nearest Public Sewer Line / 0 r '¢ To Nearest Public Sewer / Cleanout/Manhole 4o0 r 4— To Nearest Sewer Service Line' on Lot 1 (7 Water Sample Collected by D-� ' aM I n S (AJ ni IL. ; Date Water Sampl Comments B. SEPTIC/HOLDING TANK DATA Q N To tj I / C Se_�"W &�7� Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Size Air -tight Caps (Y Pumping/Maintenance Contract on File Holding Tank High -Water Alarm (,YaN) Separation Distances from Syl5fic/Holding Tank: To Water -Supply Wel To Property Line To Water Mai ervice Line Cour Comments Page 1 of 2 72-026(11/84) No. 9J Compartments Foundation Cleanout (Y/N) Date Last Pumped for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Fi To Water -Supply Well _ To Building Foundation Lot To Water Main/Service To Stream/Pond/L e/c To Driveway Comments/ D. LIFT STATION Major Drainage Course ing Area, or Vehicle Storage Area Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments /Ya div Type ofSyst Design Lengthof Fi Dep of Field Gravel d Thickness Standpipes Present(Y/N) — Date of Last Adequacy Test To Property Line To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) Dimensions Manhole�Act-ess (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that 1 h ve checked, enfie , or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signe �/ Date t7g� Company MOA No. Receipt No. 3� 7�,�9 % e��� A4��j®'®� Date of Paymentco �� p • ®�Trf ®°. j © Engineer's Seal Amount: $ '� r — e tr•00640.0•••ee•e eee ••_ . e:1 • e a ©. YNE 11 .N DEItSON e n sc CE -4488 Page 2 of 2 4m�,,,47 • ° c ®®1/P A� 72-026 (ivaa) ®qtN , N . a� Time APPLIC, IT FILLS OUT UPPER HAL` ONLY Time(`� __v Time .i Property Owner L;�1i �� i ;--f f- -`� `' �; --f- � - Phone Mailing Address Date G -' U���: Zip Code Inspector Inspe+ctoer'� f ` V Address �;-;' -r Zip Code Lending Institution 1 MUNICIPALITY OF ANCHORAGE DEPT. Phone Address i�-i ;3 i- ; ."� _ %�`,1 Zip Code Realty Co. & Agent Phone Address DATE 11 — I0'e3 Zip Code Legal Description �. ��- 'fes isi0,D (,- Soils Rating Date Sewer Installed Well To Absorption Area Well Log Rece'. Street Location -. Well to Tank Type of Residence ❑ Single Family ❑ Multiple Family No. of Bedrooms— edrooms—LJ-Other LJ- Other Water Supply - 0 -Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attachlogif available). ❑ Public Utility Sewer Disposal ❑ Individual Year Individual Installed:% ❑ Public Utility When Connected to Public Utility: ,O -Holding Tank - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time(`� __v Time .i Ls__�`C—U- (2, 1, Date Date Date G -' U���: Date 1l - -g3 Inspector Inspector Inspe+ctoer'� Inspect<o n `/ YJ�JI��A� �j :FielNotes: !lUJJ 1 MUNICIPALITY OF ANCHORAGE DEPT. n n OF HFi,LTti <:: ENVIRONM'INl"AL PROTECTION Uj ti ( ) APPROVED BEDROOMS r /� i7 'CONDITIONS OF APPROV L ( )DISAPPROVED IV.V•�("'�_/i�� w�O —44A ( ) CONDITIONAL APPROVAL - DATE 11 — I0'e3 BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Rece'. 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