HomeMy WebLinkAboutT12N R3W SEC 9 LT 16 150 X 190TI 2N R3W
C. 9
Lot 16
#014-172-07
Municipality of Anchorage
Community Development Department
On-Site Water and Wastewater Program
4700 Elmore Rd. * P.O. Box 196650 Anchorage, AK 99519-6650 · http:/flvww.muni.org/onsite · (907) 343-7904
Well Decommissioning Log
Legal Address:
Subdivision Block Lot
T !'~-/,,.~ R 5(~ Section ~ Lot l(..4,
On-site Water & Wastewater Program certified contractor performing the well decommissioning:
Company:
Well decommissioning date
Signature:
Method ofdecommissioning: AMC 15.55.060L1 a. [] b. []
Location: Use the space below to provide a drawing of the property showing the following items;
North arrow
Decommissioned well,
· Other water wells on the property,
· Two separate swing-tie distances for each well shown on the drawing,
Note: The swing-tie distances shall be measured from either permanent structures or the property corners.
G:~Community Development~Development Services\Building Safety\On Site Water and Wastewater\Fonms\Client Forms\Well Decemmisioning form.doc
Michael N. Anderson, P.E.
CiviFStructural Engineering & Construction
4661 Natrona Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
Sept 2, 2014
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re:
Legal:
Well and septic decommissioning
T12N, R3W, Sec 9, Lot 16, 150 x 190 (Tax ID 014-172-07)
To Whom it may concern:
This letter my statement that the existing well and septic have been decommissioned per the Municipality of
Anchorage On-Site Septic regulations. I have also attached a survey asbuilt of the property showing the
location of the well and septic. The bldgs have been removed.
Please call me if you have any questions.
Sincerely.~
M~N.~Anderson, P.E.
From: s holt To: NORTHERN PACIFIC
Date: 11/20100 'rime:
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Page 2 of 3
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THE INFORMATION HEREON IS FOR THE USE OF LENDIN ~G INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEE
EXISTING STRUCTURES AND PLATTED LOT LINES OR EAoEMENTS AND IS NOT TO BE USED FOR POSITIONING AB DITIONAL
STRUCTURE~ OR FENCELINES, '
EASEMENTS OF RECORD, OTHER TH^N TH:OSE SHOWN ON THE RECONDED PLAT, ARE NOT SHOWN HEREON.(UNLESS IND
ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS.
NOTE: ANY FENCELINES SHOWN ARE LocATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LII',
OR LOCATE STRUCTURES,
AS-BUILT SURVEY
NO CORNERS SET THIS DATE 1" ~ 30'
HEREBY CERTIFY THAT ~ HAVE PERFORMED A
VIORTGAGEE'S INSPECTION OF THE FOLLOWING
}ESCR IBED PROPERTY
"~rCHORAGE RECORDING DISTRICT, ALASKA ANO THAT
FHE VISIBLE IMPROVEMENTS SITUATED THEREON
hCITHIN THE PROPERTY LINES AND NO VISIBLE
!NCROACHMENTS EXIST OTHER THAN NOTE()
AT ANCHORAGE, ALASKA THIS 13T4