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HomeMy WebLinkAboutT15N R1W SEC 19 LT 18A ~ i MUNICIPALITY OF ANCHORAGE i · DEPARTMENT OF HEALTH & ENVIRONMENTAl[. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION REPORT NAME PHONE [] NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS , TA C TO, I , ~ ~/aO/ I Absorption area Dwelli~ ~ / .  Man ufacturer/~~ ~ ~ater~i~ ~o. of compartments Liq. capacity in gallons H~EMADE: Inside length Width Liquid dep~ ~ ~ ~ DISTANCE ~O: WelJ Dwelling PERMIT NO. O ~ < Manufacturer Material Liquid capacity in gallons ~ Well I Foundation Nearest lot line PERMIT ~ ~ DISTANCE TO: ~/OO ~ /~~ ~ ~ ~ No. of lln Length of each llne Total length of lines Trench width Distance between lines ~.~ Topoftiletofinisl~g~ev, -- -' - Material beneath tile ~' i.~ Total effe~v~ion area Length Width Depth PER~IT NO. < h Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO; D pth ' ~/~~ ~ ~¢~) ~t~/~ Distance t et line PER~~ ~ DISTANCE TO: Bgildin~,~oundation Sewer Ii n~/~__~. ~ Septic tank~?~ ( Absorptions.area(s) PIPE MATERIALS SOl L TEST RATI NGt INSTALLER I1' I;,I 72-013 fRev. 3/7B) / PERM I T FIF:?L. i CF!NJ' S.=FIM:=IN CONST :OCF~T i ON C!:_'GFiL. L:i.8 S:t.D T±.SNR:LN T?PE OF' SOIL FI[%:,ORP-F!ON LO'T 'EtZE ,:a,=Pae,:~,:~ SC!UFIR[~:: FEE]" P!F!i:-:i'It"ILIM ".. "lr::[:'F: OF E:Er_':d:;;:O(}M::~ = :ii: LU.~ i-::H!iNG (SQ FT,---'Eh:":,= THE L.ENGTH ©!MENSiON IS THE LENGTH (IN F'EET) OF' THE TRFENCH OR [)K:RINFIELD. THE DEPTH OF R TRENCFI OR F'IT :['_'~; THE DI..97TF:tNCE BET!.4EEN THE SURFF!CE OF THE GROUN.[> RND THE 80TTOM OF THE EXC:RVF!TION (IN FEET). THERE 1:5 NO SET' HIDTH FOR TRENCNES. THE' GRRVEL E.',EPTH iS THE NINii"iUM DEPTH OF GRF!VEL E:ETHEEN THE OLITF;qLL F'IF'E FiND THE E',OTT'O['I OF- THE E,'.'.~C:FFv'FIT!ON <IN FEET). ........... d, , k -.P. N I HRS 'THE F~'F:'cP-N'z TE t iT'¢ TF I,IF LF..N TH'r': [:,EF'RRTMENT [:,tJRIi'.~(~ -r'N- ZNST£a, LI. eTZON IP.i'FF'FiT!3NS OF ~N',/ I,.IEL. LS FiDJ'F. ICENT 'TO 1'Njc PROF%RT¥ F!NrD THE ?.gJME~ER OF' ,-.,-._,~EBiqL.~.~ THFfT TH[ NEL.L HILJ_. E:FfE:I<F:!LLING OF' '~J ' ':"":' '-' :~ -' '~',"F h'.., _,~-_,]Ei't HI-rHE...T FINRL iNSPEC:TION f~['.~[:, I-F-RL, .tL. E TNIS [:,EPF~R'I"HEH-F ,..!.,. LL ,~: E SUE:..iECT TE PROSE"CUT I ON. MINIMUM D]:STF:tNC:E E::E'THEEN R HELL. FIND fiN"/ ON-SITE SEHRGE C, ISF"OSRL S'¢STEN ZS J..E)Ei FEEl' FOP. Ft F'F'.FCFITE: F.!EL.L. OR :l. SiZt TO :2C~EI FEET FROH F! F'UBL. IC HELL DEPENDING UF:'ON THE TYPE OF F'UE~LZE: HEL..L. MINIMUM E:'iS]"RNCE FROM R F'R:[b'F~"I"E HELL TO R PRI',/flTE SEI.qER LIF,IE IS 25 FEET RbiD 'TO R COMidLINIT'¢ SE!.qER !....ZNE IS 75 FEET. OTHER REQLIZREMENTS t"IR'-? RPPL.'¢. SF:'EC:ZFICflTIONS F~I',ID CONSTRUCTION DIFiGR~MS faRE f~'v'F:!ILFIE:LE TO lb!SURE PROPER ZNSTRLLFITION. I CERTIF? THRT ::L: I RN FFfi',!!LIf:IR H ITH -['HE REQUIREMENTS FOR ON-SITE SENERS fiND HELLS RS SET F'ORTH E:¥ THE MUNZE:IPRi._I-FV OF FtNCHORRGE. 2: Z HILL iNSTRLI. THE ?./STEM It.,l flE:CORDRNCE HZTH THE CODES. 3: I UNDERSTRN[) T'HRT THE ON-.SiTE SE!4ER SYSTEM MFI'¢ REQUIRE ENL..FIRGEHENT :fF:' THE RESIDENCE: !S RENC~DELE[:, "f"0 !NCL. UE:,E MORE THRN 3 BEDROOMS. S ZG,'..,EC,: .................................. ~~/!' O & E ENG,.;IEERING & DEVELOt .~ENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Name: Mailing Address: Legal Description: LoT- Earl EllI~ 688-2280 SOIL LOG 17', 7-/&-/,z, /~/'~, ~ .~. Depth (feet) Soil Characteristics m 5__ 6__ 7__ 8__ 9__ 10 11__ PLOT PLAN 12 14 15 16 PERC. TEST ,%,,'-- [ Ground Water Encountered: Yes__ No "If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Performed by: MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# 1. GENERAL INFORMATION (Must be completed prior to submittal) Location (address or directions) HHN Spruce Crest (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 18¢h T15N, R1W; Sec.19 ("f~,.L~ /~t%,',~ ~7¢'/¢0.~-t')? (b) Property owner H.U.D. Telephone: (home) Business 271-4342 Mai[ingAddress ~22 N. 8th Ave. (Bo× N-64) Anchorac~e. AK 99813 (c) Lending Institution Telephone Mailing Address " (d) RealEstate Companyand Agent Assncia~d Brokers Address 640 W. 36fh Av~.; ~nif~ ~1 Anchorage: 563-3333 Telephone (e) Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: Pick up by Engineer 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3 3. WATER SUPPLY individual Well [] Community [] Public El Note: If community well system, must have written confir~nation from the State Department of Environmental Conservation attesting to th legality and status. 4. sEwAGE DISPOSAL On-site ~q 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 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION , .. As certified by my seal affixed he reto and as of the validation date shown below, I verify that my investigation of th is 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 ofFirmEagle River Engineering Servs-Felephone 694-5195 Address P.O.B. 773294 Eaqle River, AK 99577 Date 6. DHHS APPROVAL Approved for J Approved ~ Disapproved Conditional Terms of Conditional Approval ~Fhis residence has been vacant and the septic system dormant for 16 months. The s~ptic system consists of a deep trench installed in July, 1982 in relatively tight soils. An adequacy test of the absorption system was last performed in July, 1988. Without now being pre-soaked and retested there is no assurance that the septic system will be capable of handling the wastewater for an extended time period. ~,~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The M un ici pality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-088 (Rev. 7/88) BacX Page 2 of 2 !: ~d~,~ A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~, /~ Well Log Present (Y/N) /'" Date Completed ,~-'-';'"~ .z',-,~-. Total Depth -r~'o ' Cased to ~'~'~ ~ Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Static Water Level /¢ ~¢" /],~/,--' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line . To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~'/~¢ Pump Set At ~'¢¢ ' Sanitary Seal on Casing (Y/N))" Depression Around Wellhead (Y/N) ; On Adjoining Lots /,¢ ~ ~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date SEPTIC/HOLDING TANK DATA Date Installed /Ca~-z Size Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) /'" Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~'/~ No. of Compartments ~P' Foundation Cleanout (Y/N) Date Last Pumped :~/~'~ ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ?/'P ~ To Property Line ;~'~ / To Water Main/Service Line ,'-/o / To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field ~' / Comments 72-026 (Rev. 7/88) Front Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ~' '¢ / Depth of Field ,5: ' Gravel Bed Thickness /~' / Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /¢ 3' ' To Building Foundation /¢ ~' Lot~o*/~' *-~- ~e-f~.c...,k,e ~ ,.-~,-~ ; On Adjoining Lots To Water Main/Service Line ¢/¢ / To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /~c ~f,~'~ ~ ~ ~4~ Y To Property Line /¢ / To Existing or Abandoned System on D. LIFT STATION ,,¢//~ r Date installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guideli?.e~-Ip effect on the date of this inspection. ,:. :.:: Signed ,,,/./'.'/q/~ 5 P, O. Box 773294 Date MOA No. ~p 2-~F 694-5195 Receint No ¢~-//~c~c~ Date off PaYment //--/,~ --~? ~'~ 72-026 [Rev. 7188) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Seal MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERT,F,CATE ,NS ECT,ON HEALT ^UT OR,TY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date July 6, 1988 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 18 T15, R1W, Sec.19 Location (address or directions) Spruce Crest (b) Applicant Name [-~D (~-ic D~r~ud) Telephone: Home 563-3333 Business . :; : 'i Applicant Address c/o Ass. Brokers 640 W. 36th Ave. Suite #1 .~ch. AK (c) Applicant is (check one): Lending Institution []; Owner/builder:~; Buyer []; Other [] (explain}; 99503=5807 (d) Lending Institution Address (e) n/a Telephone Real Estate Company and Agent Address n/a Telephone (f) Mail the HAA to the following address: ........ Pick-up by Engineer TYPE OF RESIDENCE Single-Family [~ Multi-Family [] 3 Number of Bedrooms Other WATER SUPPLY Individual Well~] 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 Environmenta Conservation attesting to the legality and status. 72-025 (11184) Page I of 2 ENGINEERING FIRM PROVIDING ,.,,.4PECTIONS, TESTS, FILE SEARCH, DA'L ,ND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of thi~ 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 Eagle River Engineering Services Telephone 694-5195 Address P,O,D. 773294 Eagle River: Alaska 99577 Date DHEP AppROvAL , . ' · Approved for .~¢z/~X-/~,~,~ bedrooms by . . _ Approved ~ Disapproved Conditional __ Terms of Conditional Approval Date 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 federaJ 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) uN[CiPAt. I'[Y OF ANCHORAGE iRONMEN'[AL SERVtCES DIVISION JUL 6 R£C£W£D WELL DATA MUNICIPALITY OF ANCHORAGE (MOL/' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Z~ S~ ,j~' Well Classification Well Log Present (Y/N) ,~ ~ Date Completed ~¢~,~,'~'~r ~'.~a',~.~- .~ /?'pC, Yield Total Depth ~o ' Cased to ~'~'~d~/' Depth of Grouting .',.//,i Static Water Level J$ ~ '" ~/~.~. ,'~ ,~¢' t'~'w&wa' Pump Set At ¢'~ //~ Casing Height Above Ground .2o "' Sanitary Seal on Casing (Y/N) Ii~ A, B, C, D.E.C. Approved (Y/N) /t,//~l Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line '"~'/~ Cleanout/Manhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots /~' ~' / ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed /~'¢f"~ Size Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) '"~'/'~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~'/¢¢' *' To Property Line ¢'/~' ' To Water Main/Service Line ¢'/~ Course ./t,"/..~ No. of Compartments /v Foundation Cleanout (Y/N) Date Last Pumped ~//,P~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ~ To Disposal Field ~ / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) 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 Field: To Water-Supply Well /~ 2' To Building Foundation ,~ /~' · Lot ~T~,~ t,/ .~,#¢.- To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area. or Vehicle Storage Area Type of System Design Length of Field ~"¢~/! Depth of Field ~> '/ Gravel Bed Thickness _ ~ / Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ~Adjoining Lots + ~'¢ / To Cutbank (if present) ,,~,,/.~ Comments LIFT STATION/,v/A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Bating Against HAA Request I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~'~¢~-~ Date Eagle River Engineering Services Company ,P, O.~o× 7732?, MOA No. Eagle River, AK ~9577~ ~ Receipt No. 69~-51~5 ~ / Date of Payment '~ Amount: $ Page 2 of 2 ~', 72-026 (11/84) .~,UNICIPALITV OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONN~ENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4720 Application Date ~7' / (~i / GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~:*'"'¢~'-i '~%/'* ~ Telephone: Home .~(¢~'-Z~'/¢~ Business Applicant Address (c) (d) Applicant is (check one): Lending Institution []; Owner/builderJ~(; Buyer []; Other J~: (explain); Lending Institution ,.~ o~.~ .... Telephone Address (e) Real Estate Company and Agent Address Telephone (f) e HAA to the following address; TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well,~ 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 Ta~k [] Note: If community Well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCFI, 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 disposaJ system is sate, 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 sy§tem is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ ~'. Date .Telephone Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmentat Protection (DHEP) !ssues Health Authority Approval certificates based solely upon the representa.tions 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 MUNICIPALITY OF ANCHO~,,~E ' DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) .ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) JUL 2 5 lg85' CHECKLIST-264.4720FEBRUARY 1984 I E6EIVED Legal Description: ~ WELL DATA Well Classification Well Log Present (Y4~ Total Depth ~'~- Static Water Level ~, ~', If A, B, C, D.E.C. Approved (Y/N) Date Completed ['¢~q ~ Yield Cased to (~"~-- ~ Depth of Grouting ~ ~ ~ Pump Set At LS, ~,4.... '"~¢"~ Sanitary Seal on Casing([~N) Depression Around Wellhead (Y~ Casing Height Above Ground Electrical Wiring in Conduit~;)N) Separation Distances from Well: To Septic/Me:d:;~g Tank on Lot I ~'~ I ~.. ~-~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ ~ Pr' ; On Adjoining Lots ~/~' TO Nearest Public Sewer To Nearest Public Sewer Line ¢ /~- To Nearest Sewer Service Line on Cleanout/Manhole Water Sample Collected by ~ ~ ~/'~v~),-¢c~¢4~ ;Date Water Sample Test Results ~'~/~¢~"~ % ¢~~ Comments E;::~vJ~,--N¢~7--~ ~ ~¢_.~..~tl~::>~.~ ~¢.~,.,_.~¢¢'1..~-¢~ B. SEPTIC/It~t~t~=,TANK DATA Date Installed ~'~ '¢~ ' Standpipes ~'~N ) Depression over Tank (Y/~_ Pumping/Maintenance Contract on File (Y/N) / Holding Tank High-Water Alarm (Y/N) Separation Distances from Sept c/M ...... _~Ta . To Water-Supply Well ~ L.~O -F To Property Line ~ b To Water Ma4-P, CService Line Course Size ~, ~'.-¢~ No. of Compartments ~- Air-tight Caps (~/N) Foundation Cleanout (Y,~ Date Last Pumped ~ ~ '~ ~ ~-~'~ ~ Temporary Holding Tank Permit (Y/N) To Building Foundation ~ To Disposal Field ~, ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata "2-~t ~- 4; ) d-~:~ Type of System Design Date Installed "~ - 'Z-'2-~ - '~'2~- v Length of Field .q~£1 Width of Field '57'¢~(.~ ~ Depth of Field ~ t Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well 1 ~ ~- To Building Foundation f..j¢~. Lot ~' ~'[ Gravel Bed Thickness Standpipes Present Date of Last Adequacy Test To Property Line ~, ~ 'd- To Existing or Abandoned System on ; On Adjoining Lots '"5-6> * 4 To Water Ma~/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutbank (if present) [tx D. LIFT STATION Date Installed ' Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) ~.~ _/~ "Pump Off" Level atvent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date MOA No. Signed ~r~ ,~ ompany ~. ~-2~!~ Receipt No. _ ~35 t Date of Payment ~'~b Amount: $ . ~ .Ob Page 2 of 2 72 026 (11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Environmental Health Division CASE REVIEW WORKSHEET CASE NUMBER: DATE RECEIVED: I COMMENTS DUE BY: S-8693 November 30, 1987 JDecember 21, 1987 SUBDIVISION OR PROJECT TITLE: ( ) PUBLIC WATER AVAILABLE ( ) PUBLIC SEWER AVAILABLE ( ) COMMUNITY WATER AVAILABLE 71-014 (Rev. 5/83) November 18, 1987 Platting Office 632 W. 6th avenue - Fifth Floor Anchorage, AK Re: Vacation - Government Lot-18A, Section 18, T15N, R1W, SM Attn: Jo-Anne Contreas The main reason for requesting the above vacation is because the owners house is within the existing 50' B.L.M. Patent R.O.W. reserve. Vacating the South 20' will have no adverse effects on neighbors, will leave a 30' R.O.W. which fulfills Municipality of Anchorage specs, and will relieve the owners of their problem. Thank you, Tom Dreyer Vice Pres±dent ENGINEERS PLANNERS SURVEYORS LAND TECHNOLOGIEIS, LIMITED 440 W. BENSON, SUITE 103 ANCHORAGE, AK 9S503 ran-~ .~R2~5291 VACATION OF RIGHT-OF-WAY OR EASEMENT APPLICATION Municipality of Anchorage DEPARTMENT OF COMMUNITY PLANNING P.O. Box 6650 Anchorage, Alaska 99502-0650 OFFICE U S E~.. REC'D BY VERIFY OWN . A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks. Case Number (IF KNOWN) 1. Vacation Code Abbreviated Description of Vacation (EAST 200 FEET SOME STREET) --~.. :- - ?] Existing abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOT 34). 4. Petitioner's Name (Last ~ First) IPIol~lfl~l It Isl~l~!~Pl~l I I I t I '1.1 Address City ~[',¢$z.E .~]V/~ State "~/~ PhoneNo. g,~q- ~]~g Bi, Me 5. Petitioner's Representative M l l,d bl l I I I I I t I I I I I I I I I I Address 4/'Z'/O' V''/' I~'~''J-'~tJ City .4,v~/~ State Phone NO. ..~2- -~ ~'~'/. Bill Me 6. 9. Traffic Analysis Zone Petition Area Acreage 7. Proposed Number 8. Existing Number 10. Grid Number 11. Zone ~-;I' I ~t.sl~ 12. Fee $ 13. Community Council I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to vacate it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances, I understand that payment of the basic vacation fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the vacation. I also understand that additional tees may be assessed if the Municipality's costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have to be postponed by Pianning Staff, Platting Board, Planning Commission, orthe Assembly due to ad ministrat~L[.re~[ ~.[ Signature ~ ~'~a~ ~t' '~"" ~' "'"'" 'Agents must provide wri~en pr f or ho ~on. 6 ~988 C. Please check or fill in the following: 1. Comprehensive Plan -- Land Use Classification '~ Residential Commercial Parks/Open Space Transportation Related 2. Comprehensive Plan -- Land Use Intensity Special Study 3. Environmental Factors (if any); a. Wetland 1. Developable 2. Conservation 3, Preservation Marginal Land Commercial/industrial Public Lands/Institutions Dwelling Units per Acre Alpine/Slope Affected Alpine/Slope Affected Industrial Special Study b. Avalanche c. Floodplain d. Seismic Zone (Harding/Lawson) Please indicate below if any of these events have occurred in the last three years on the property. Rezoning Case Number Subdivision Case Number Conditional Use Case Number Zoning Variance Case Number Enforcement Action For Building/Land Use Permit For Legal description for advertising· Checklist 30 Copies of Plat Reduced Copy of Plat (SY2x 11) Certificate to Plat Fee ~/ Tope Map 3 Copies Soils Report 4 Copies [ ' Aerial Photo ~/ Housing Stock Map ~ Zoning Map ~V Water: '~ Sewer: Private Wells Private Septic Waiver Community Well Community Sys. Public Utility Public Utility PRELIMINARY PLAT APPLICATION OFFICE USE Municipality of Anchorage (~___ DEPARTMENT OF COMMUNITY PLANNING REC'D BY P.O. Box 6650 VERIFY OWN Anchorage, Alaska 99502-0650 A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks. O.Case Number (IF KNOWN) 1. IIIIIII Itti!11 Vacation Code New abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34). Existing abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOT 34) full legal on back page. [~/~1,-1 I,'1~1 Isl~l,d J/kl I-rl~l;I,~l Id~l,~l I~1//,I 4. Petitioner's Name (Last- First) Phone NO. 5. Petitioner's Representative ~-~ ,~ ~kld I I i I I I I I I I I I I I I I I Address City Phone No. State .'~/C* 6. Petition Area 7. Proposed 8. Existing 9. Traffic 10. Grid Number 11. Zone Acreage Number Number Analysis Zone Lots Lots 12. FeeS '~-~(~ 13. Community Council B. I hereby cedify that (I am) (I have been authorized to act for) the owner of the prope~y described above and that I desire to subdivide it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic subdivision fee is nonrefundable and is to cover the costs associated with processing this application, that ~t does not assure approval of the subdivision. I also understand that additional fees may be assessed if the MunicipalRy s costs to process this application exceed the basic fee I fu~her understand that assigned hearing dates are tentative and may be have to postponed by P ann ng Staff, P atting Board, Planning Comm ssion, or the Assemb y due t~~ I}~; ~ reasons. ~] C} ~'(:[ ~ T~' S 8 ¢¢ 9~ JA~f 6 ~988 *Agents must provide wri~en proof or authorization. C, Please check or fill in the following: 1. Comprehensive Plan -- Land Use Classification [/' Residential Commercial Parks/Open Space Transportation Related 2. Comprehensive Plan -- Land Use Intensity Special Study 3. Environmental Factors (if any): a. Wetland 1. Developable 2. Conservation 3. Preservation Marginal Land Commercial/Industrial Public Lands/Institutions Dwelling Units per Acre Alpine/Slope Affected b. Avalanche c. Floodplain d. Seismic Zone (Harding/Lawson) Please indicate below if any of these events have occurred in the last three years on the property. Rezoning Subdivision Conditional Use Zoning Variance Alpine/Slope Affected Industrial Special Study Case Number Case Number. Case Number Case Number Enforcement Action For Building/Land Use Permit For Army Corp of Engineers Permit Lega~ descnpbon for advertising. 30 Copies of Plat ---~L~/V Reduced Copy of Plat (8'/~ x 11) ~-~;ertificate t° Plat Topo Map 3 Copies oils Report 4 Copies Aerial Photo Housing Stock Map ('¢¢-~/ ,. ,/' Zoning Map Water: Sewer: Waiver Private Wells Private Septic Community Well Community Sys. Public Utility Public Utility LEGEND 0 FOUND EXISTING RESAR ~ SET MONUMENT R RECORD PLAT OF ORIGIN NOTES: PLAT Of ORIGIN IS U.S. DEPT OF THE INTERIOR BUREAU OF LAND BL.M 2640.00[R) "C RGB° ,~7' ~z" w fro .--' I- BBO.18 SURVEYOR'S CERTIFICA TE PLA T APPRO VAL CER TI F/CA TE OF OWNERSHIP and DEDICATION AUTHORIZED SIGNATURE PAUL O. JOHNSON aS~ WEST 8?h AVENUE ANCHORAGE AK 99501 POSITION NOTARYACKNOWLEDGEMENT · DT1002480 ACCEPTANCE OF DEDICA T/ON VICINITY MAP SCALE I" = I MILE SO T IS N A PLAT Of:: GOVERNMENT LOT 18-A ~'WITH VACATION RES, NO. 8B-'(0" ~'40 W. BENSON BLVD. ANCHORAGE:, AK. 9950B