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HomeMy WebLinkAboutCALAIS BLK 3 LT 2x 009�034�37 MUNICIPALITY OF F ANCHORAGE i� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section uq�_LJ Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 009-034-37-000 Expiration Date: 9/18/2025 Legal description CALAIS BLK 3 LT 2 Site address 3006 EUREKA ST Anchorage AK 99503 Current property owner(s) FILKINS ELIZABETH A X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: 1A Original Certificate Date: 10/10/2024 Thi6 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 Approval June 2022 MUNICIPALITY 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. 009-034-37 Complete legal description Calais Block 3 Lot 2 Location (site address) 3006 Eureka Street, Anchorage, AK 99503 Current property owner(s) Elizabeth Filkins Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 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 0 Community Septic or Public Sewer Age N/A - See advisory if steel older than 20 years lwJ����i J►������A������'�����1�����1Gi����:��a���l�i�P1����'171�1:��Nllil�lN=MNIIIIe.r'.is, i -7m I Ism 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-g Date of Payment J COSA# Z1-1 1 y05 Waiver Fee $ Date of Payment Waiver # COSA Application_ June 2022 Calais Block 3 Lot 2 N/A N/A N/A > Benjamin Schiller, P.E. (907) 522-7773 MUNICIPALITY OF ANCHORAGE C) Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 009-034-37-000 Expiration Date: 2/1/2024 Legal description CALAIS BLK 3 LT 2 Site address 3006 EUREKA ST Anchorage AK 99503 Current property owner(s) DANIEL SAMUEL E & KATHLEEN X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 11/1/2023 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 Approval_June 2022 � UNIMPAUY OF AmCH0 E .......,._� .. 1 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. 009-034-37 Complete legal description Calais; Block 3, Lot 2 Location (Site address) 3006 Eureka Street Anchorage, AK Current property owner(s) Sam Daniel 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 907-227-4626 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 9 Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age NSA - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: N/A 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 '�5 O Waiver Fee $ — Date of Payment _ /0/2 Date of Payment COSA # 05 G 2 31 LJ I s Waiver # COSA Appl(caUon_June 2022 Legal Description: Calais; Block 3, Lot 2 Parcel ID: 009-034-37 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled *5/1975 Total depth *112 ft Cased to unk ft 0 Sanitary seal is functioning correctly R Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 10/10/23 Static water level at beginning of test 21.2 ft. Comments *Per MOA records B. TANK DATA Measured operating fluid level in septic tank _ Date of pumping ❑ Required maintenance completed, if AWWTS Comments: Public Sewer D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A - pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant o�pTeld not used for more than 30 days prior to dat f test) Gallons introduced Any rejuvenation atr If yes, ent date COSA Checklist June 2022 _gallons ' date (past 12 months) N/A -Public Sewer Well production at time of test *5.0+ gpm Water storage tank volume N/A gallons Wel disinfected for coliform test? ❑ Yes No [Coliform bacteria is Negative Nitrate mg/L [Nitrate less than MRL (ND) Arsenic ug/L eArsenic less than MRL (ND) Collected by GEG, LTD Date 10/10/23 C. LIFT STATION ❑ Required maintenance compl Age of lift station year Lift station material Comments: Public Se r Adequagoest date R . Its n Pass id depth prior to test in Water added - gal New fluid depth - in Elapsed time - min Final fluid depth - in Absorption rate - gpd FIELD STATUS - POST RECOVERY Effective depth (per record drawings) _ Effective depth used - in Effective depth remaining in in rz —Lr_ h? E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' 50+ ❑Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' [:]Yes if No **unk ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' FE -1 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ❑i Yes if No ft Community Sewer Main > 75' ❑ Yes if No *50+ ft Manure/Animal Excreta Storage > 100' 0 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' Yes if No ft ❑ Yes if No ft ❑ Yes if No ft ❑ Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ❑ Yes if No ft ❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *Met code at time of installation **No code requirement for separation at time of installation G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Garness Engineering Group, LTD. (GEG) Phone 907-3/37-6179 Engineer's Printed Name Jeffrey A. Gayness Date 10121/ 2.3 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 o 0 A o g d p _ ..._ ._.. ...... g$ ..... •.Jeal e A �Garnlss �d49. '. —79{3I. � G UCENSE� �aP�oiession°©o #AECC884 a t _ N89'47'17"E 114.63' Cli 01 Z, "n'Block 24. D 5 Side Setback N 89*47'17" E 114.63' 20' ROW Lot 1 I 0 is 30 1 Star USSURVEY FEFF Surveying 31 st AVENUE 60' ROW NOTES -All dimensions shown are grid bearings and ground distances, record boundaries are per Plat No. P-522. 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 establishment of property lines. -It is the owners responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed. A 4Z BUILT SURVEY Lot 2, Block 3, LCaglaAiLsLSuUbRd2ijL'jU'dTt, LEGEND QW Well Mailbox Utility Pole 49th Star Surveying LLC 321 Fireoved Drive Anchorage, AK 99508 (907)891-6111 W-0. 2012 1 DATE 05/21/20 SCALE 1"=30' 20' Front Setback I 0 is 30 1 Star USSURVEY FEFF Surveying 31 st AVENUE 60' ROW NOTES -All dimensions shown are grid bearings and ground distances, record boundaries are per Plat No. P-522. 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 establishment of property lines. -It is the owners responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed. A 4Z BUILT SURVEY Lot 2, Block 3, LCaglaAiLsLSuUbRd2ijL'jU'dTt, LEGEND QW Well Mailbox Utility Pole 49th Star Surveying LLC 321 Fireoved Drive Anchorage, AK 99508 (907)891-6111 W-0. 2012 1 DATE 05/21/20 SCALE 1"=30' SGS Ref.# 1235750001 Client Name Garness Engineering Group, Ltd (GEG) Project Name/# Calais; B3, L2 Client Sample ID Calais; B3, L2 (Pre -Filter) Matrix Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 10/27/2023 12:13 10/10/2023 17:30 10/11/2023 15:08 Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 B (<10) 10/13/23 10/17/23 HOS Waters Department Total Nitrate/Nitrite-N ND 0.200 mg/L SM21 450ONO3-F C (<10) 10/13/23 EBH Microbiology Laboratory E. Coli Negative 1 100mL SM21 9223B A 10/11/23 M.A Total Coliform Negative 1 100mL SM21 9223B A 10/11/23 M.A 2of7 MUNICIPALITY OF ANCHORAGE Development Services Department% Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 009-034-37 1. GENERAL INFORMATION Expiration Date: 15: Q D,1v Complete legal description CALAIS BLK 3 LT 2 Location (site address) 3006 Eureka St Current property owner(s) LIGHTLE STEPHANIE Day phone 441-4114 Mailing address Real estate agent LIGHTLE Day phone 441-4114 COSA Fee $ 96 Date of Payment L1I,7Iaaa0 Receipt Number oP I Q —154D COSA# 6tC961135, Waiver Fee $ Date of Payment Receipt Number Waiver # 2. TYPE OF DWELLING: ' 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 h� 0z68L95 ti 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer El Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 96 Date of Payment L1I,7Iaaa0 Receipt Number oP I Q —154D COSA# 6tC961135, Waiver Fee $ Date of Payment Receipt Number 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. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 4/6/20 6. DSD SIGNATURE=f= System #1 Approved for bedrooms System #2 Approved for bedrooms I_ Disapproved Conditional approval for bedrooms, with the following stipulations:`=�u:`,;y_ By: Original Certificate Date: y 15 d oho 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: CALAIS BLK 3 LT 2 Parcel ID: 009-034-37 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5/75 Total depth 112 ft Cased to unk ft X Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/620 Static water level at beginning of test 20 ft. Comments Arsenic Treatment B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes 0■ N R Coliform bacteria is Negative Nitrate mg/L X Nitrate less than MRL (ND) Arsenic ug/L A Arsenic less than MRL (ND) Collected by NRim Eng Date of Sample 4/1/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft F1 Yes if No 50+ ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100'✓❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50'✓❑ Yes if No ft ❑✓ Yes if No _ _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' E] Yes if No 50+ ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS 50' Separation To Sewer Line Met Code At Installation Time 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. COSA Checklist yellow sheet • • 0678970 ,/,e° 80‘ Municipality of Anchora orb �m�. '; rp On-Site Water and Wastewater Progra . -0 (907) 343-7904 - MAR ; a. 3 Certificate of On-Site Systems Ap 0, 1o 68L95 Parcel I.D. 009-034-37 Expiration Date: kLa4.1 )� a 01 1. GENERAL INFORMATION: Complete legal description Calais; Block 3, Lot 2 Location (site address) 3006 Eureka St.*Anchorage,AK 99503 Current Property owner(s) Susan &Mary Kiely Day phone 306-6149 Mailing address Real Estate Agent Ranna Fekrat Day phone 441-5815 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: Received by: .�� Date: 117 Z / I 8 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ ? . Waiver Fee $ Date of Payment I/42 i 1 r Date of Payment Receipt Number d! 1 I Receipt Number COSA# Cr2e--I t ( e 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 3 24 . 1`‘%\, In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o Q f r in accordance with the guidelines and regulations established by the Municipality of Anchorage and d� ••••• Aindustry practices. The reported results describe the condition of the system/s on the date/s of the 4 P. ' ,�()A evaluation. Separation distances were measured to readily identifiable features. Hidden defects or • ()GI encroachments may exist that were not identified during the evaluation. The operational life of all wells 4 H �* IV and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and 4 vA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and Q .... 0 are outside the control of GEG. Satisfactory test results do not guarantee future performance of the g •J:•ff e A. Carnes.. system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of QO '/ _79• the well or septic system. GEG makes no representation whether an alternative well or septic system Q's ,!s� •�c�� can be installed on the property in the event either of the current systems fail to perform adequately in �D�P,e .Z ? ./ the future. The content of this report is for the sole benefit of the person/party that retained GEG to %% dprofessi000\ perform the evaluation. Reliance upon the information provided in this report by any other person or D 400 > party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved ��\( OF AN�No. Conditional approval for bedrooms, with the following stipulatl : ON-SITE WAThR AND WASTFWATER o PROGRAM wPAp- gc1\ C n� vz01 gy. (A,,,�',,�,�►4 Ci,c,,� ;M j;,M �'ck,u�;-,� Original Certificate Date: �1� 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 Nitrate Advisory Septic System Advisory Arsenic Advisory )C 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: Calais; Block 3, Lot 2 Parcel ID: 009-034-37 A. WELL DATA *Per MOA records Well type Private If A, B, or C provide PWSID# — Well Log (Y/N) No Date completed *5/1975 Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes Total depth *112 ft. Cased to Unk ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 3/27/2018 / Static water level \146\\ vogft. Unk ft, No Well production / g.p.m. 3+ g.p.m. WATER SAMPLE RESULTS: Coliform Ne9 colonies/100 ml. Nitrate ND mg./L. Collected by: Pannone Eng. Srv. Arsenic: 13.1 ug./L. Date of sample: 1/26/2018 PUBLIC B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2or ft2/bdr • System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorptio - ea ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absor. in field before test in. Water added gal. New depth in. Elapsed T.- e: min. Final fluid depth in. Absorption rate >= g.p.d. y rejuvenation treatment (past 12 mo.) (Y/N & 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 '• a er alarm level at in. I- •• Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots 100'+ Absorption field on lot N/A On adjacent lots 100'+ Public sewer main *50'+ Public sewer manhole/cleanout *50'+ Sewer/septic service line **UNK Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIE P s 1 OT TO: Property line B • • oundation Water main Water service line Surface water Driveway, parking/vehicle storage . - .in drain Wells on adjacent lots F. COMMENTS *Per code at time of installation (1975) **No code separation requirement at time of installation. 0060''.N4 G. ENGINEER'S CERTIFICATION o c OF. , ,I\n I certify that I have determined through field inspections and ;� . 4 g • I .' V:57*VD review of Municipal records that the above systems are in ;� • v conformance with MOA COSA guidelines in effect on this j v date. /O •• :f '. Gar ess; 1, Engineer's Printed Name JEFFREY A. GARNESS Oa! i• CE-7954 .•'.cop 8 Ago Date 3I Z'3 i 8 Qp`'., • •':� .2. I\�o f %, ;.,,p,,ofessioao'� 40000 #AECC884 (Rev. 11/05) RUM DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site water and wastewater Section ti j Fax: 343-7997 www.muni.org/onsite -- i Arsenic Advisory Certificate of On -Site Systems Approval #OSC181117 Subdivision: Calais, Block: 3, Lot: 2 A water sample revealed an arsenic concentration of 13.1 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. ��k�.� il�i�g�A ress�O��ox.96G5�G��pnc�harage ANR199S� Sc, � l 1 ._.___. N M � •�r� �� d� cf3 ...= _ .. T. 44 . ��{•-built" • .. � f horoby rarllly th4l a survey of 1ha following daacribad properly •Ci J 1L? G/ L S 6 ' •t• C o t f .,�. �• r u. .. ._._..� trot nada on %��4��'����•�•''•�i: 7' �--_dnd that the Improvomintt alluatod thereon ora r~+ ••F r,-,7;,1 +1, l rltl;ln t, a Droporty 11441 and do oat Croda) or ancrmh on fro property aajacoal � a •.t,�••{,.•..••,,,•,•,•, t7;er:lo + thal no hproraenenIs Otl properly lying ad J4:/ht IAarata 4ncro9srl an IN i'�" ptChltia In quotllon and th4t Chir• ars no raodroyi, Irsnznnlaslon linsl or othar "ti' "" '•••••'• YI:1bla oatanonlo on aoy property oxcipi of Indicated haraon. Dotid 41 AnahorO + Aloaia I 1his u % �+r. Np• 301-5 6.0 COK;MCi 1Na E4011`:Lt:tl9 A A330C. ,�\��.�-'•��'� M E. hilarnaVarol Airport ltood Ardvro¢li, Ala Ika ID0ISOz SEAL Plona: 270-377t tai � i :• p•j ;,� N WGr t , Mt tIN o y ac sic 'e t • ..r •• • tri j • MJl1�QYlt1' • . w I hotoDy tcrllfy th4l a surrey of the following doicrlhcd propilly Lot 1 •,CSI„ ?4, �, at xot nae• on' .�J---...• end that 1ho �lmprovemintt oftuatod rh4raon its e:lthln tea Droporly Jlnac and do not oyctlop or oncrooch on N praperly ae)aceel t7;etc10 , thal na hprorse,eate Oh )raperly lying e4)4:0ht Morita ancroatfs on the Dtentiva In Rueitlon and that Mrs, ere ac roodsayt, lron:micclon lima& or War TI:IDIc oata male on NOH proporly axe-spt of ladlcdlad heraon. Dated at AnoAoreQ+, Alorta, lhle _.., •^. doy of a C.12 C. htilarnaVeral Airport ttood Ardvroeoj A1011Q 00502 PXona: 270-•3773 TAX CODE No. L--' j i GRID No. MUNICIPALITY OF ANCHORAGE --SE K UI ILII Y PROPERTY � p873 Name—�`�� .�i9.2z/�Es Address 2� 4�' Sl'• Acct.No K y-1-110 D - Doa Plat No.Subd of _Block Residential 9 Commerial ❑ Industrial ❑ No. of units CONNECT* Main Tap ❑ On Property ❑ Permit No. Size Type Drawing No. Size Main Type Depth at Connect Insulation ❑ Cieanouts Type Connect Agent Inspector Date Comments Connect Location ASSESSMENTS: L.I.D. No. Private Dev. No. Subd. Agreement ❑ No. Sewer Agreement ❑ No. P.T.E. ❑ Roil No. DYE TEST: Positive Q' Negative ❑ N.S.A. ❑ Date Page No. M.H. No. �,,2/� Billing Cycle Tested B y T l�Tirl�iri ' Comments j+ W M�y� / � W 1 O l.i W LUQ Q Ln 06 Q a a „i Z o H '1 vs I " 'a m a a O V ui a cc a U a. m ,. •CL a o a U O z a Z wLu Lu E^ Z W u 0. N 0+ N LU 3 LU H ' S. C 8 I 9 z d��Zaw�2 N 3 p p au co Y 5® a 8I oaQ= s N L 1 a L71glE4R9 W� "s N mN z <g 0' o�ga _ s•o®4000® QN 0699£ 6E90Z a e U. r A. 1 W Fp s`n j gF olaa •- V. g! 'r! 94LZ d! 4 I FF df �6Utl, £4E61. is ove a z! O m_rae 004E gz eve W oL - z0£lz`4' !g 4945E - ` 4L99L. _---' m { g IC t oz Le j moo! 0041 zs e'6, o0¢L o`� dc' ° lose:^ a 9Z66L £E4L �IVV I 669ZZ .--r laanS eAmn3 to � .ACV - d- - Wa95 eM n " " _ f `IOB 66 i 9L4 Imo_ , el LSYI !S OIZLZ _ _ U ZoSZL Uc :°z . !g 8! ove !! a g i _ Og .Ovu dd1O8 l I m �Yd L 66EL �! jI ddloe di_ Ovu ddae, lOs `,� j I 'L p N BLSSE I- LLSSE s, Si i LE4L EZZL - W Alio! L6£L I, .bd s 99ZS'. Ove L6EIL/' I , , ., " :per —2- rg Kt,%. lL£BNSd.� �2 ea Fd j 'd �. L6EL dd I �0 9�.C:-!`_/— gd !d 'L! '_ _ s° Y Ute. ✓> _fC S Y MNUZZ,1151—,Z�A--N-- ovzt.�Lllzzl� I.;.._:�! '... 96ELL _ plenalnog ovc�o rO! 7.9Z9Llo 1 d Stoves !2 ���ccc���111 m I s viae 00 $ s gs694L !p m E2 _ O nuc mm m - oo"--� — O `i_ mUU co ayc mU mmm °yam Z-<8 co co �m�,�c2 .2- D. QQUUU UUU 012 C72i aQ.m 7>55Zma f w C R- 7 mUU_�-�Z7 _U-OJW>U1-U ZU ��11 ��/11a ¢¢UUU UUU O1, U' xmaQ.w OH7>SSZ. JZ o ,Y Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 009 - 0 31/ - 3 7 1. GENERAL INFORMATION HAA# 14A- 030 10/ Expiration Date: G - �2, 5"- 0 -3 Complete legal description 6- 0f Z, r? le,- cIr 3— Ccr /ass S /1) Location (site address or directions) 3 0,0 6 Ecc r e _f/ - Current f Current Property owner(s) R o m ctn Fl -a n L Day phone 3a/ - 79 9 X Mailing address Lending agency Mailing address Real Estate Agent Mailing Address ?706A--chc 74 /}n c.A A 4c 919,5-0--? l�{� PczCtAC tlol- Day phone 7 y3 -9di3 /{@�r7Qt74r 0i- Pe Alunp_ Day phone Unless otherwise requested, HAA will be held by DSD for pickup. f'/9kz,-2 64?1/ 0' P / g7y3 - 9,0Z even 1/ -AA rlvta. .-- �.u. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer N The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority 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 F^ lg4-f e S LIci Phone 3 °is i3 s–s Address 1yS34 �c oto Sf �, ?},2zAorQ5fe. � 91.5'/ Engineer's Printed Name 7-heo406.?� T 1y0ar-67 Date Me Tv �s� 200 3 aa•••a eA»• "r Ny • �Ry 5. DSD SIGNATURE / •3 �4 w.SWL� • d r/ Approved for _ 3 bedrooms. a�9 .a ._• s, , Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ``\ l``ttt1o( OFA(it�rrrr: J ON-SITE �AIATGa Arun ti WASTEWATER :—PRe6fiir�; a. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other 1 By: Original Certificate Date: S' (Rev. 07102) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519.6650 www.d.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A%o f 24 Blv C k 3 <a 1414 S ID Parcel ID: 009 -0 3 Y- 3 7 A. WELL DATA Well type P wf If A, B, or C provide PWSID # _ Well Log (YIN) N Date completed Se F /97s7 Sanitary seal (YM) Y Wires property protected (YIN) Y Total depth 1 r 2 ft. Cased tot Yo ft. Casing height (above ground) J8 in. FROM WELL LOG AT INSPECTION Date of test 3/ x 2/ 0 3 Static water level ft. 2 i ft. Well production g.p.m. 6.6 t g.p.m. WATER SAMPLE RESULTS: Coliform U colonies/100 ml. Nitrate S, 0.2 mg.h. Other bacteria Q_ colonies/100 ml. Arsenic: mg./I. Date of sample: 3/19./ 03 Collected by: F/a Hop 7*ch S �c B. SEPTICIHOLDING TANK DATA N. A. (Acv c,V Ct Sew er) Tank Type/Material Date installed Tank size gal. Number of Compartments — Cieanouts (YIN) Foundation cleanout (YIN) ^ Depression over tank (YIN) _ High water alarm (YM) Date of pumping Pumper C. ABSORPTION FIELD DATA N. A. � A w W St w e,-) Date installed Soil rating (g.p.d.te or fefbdrm) _ System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area fe 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.) (YIN & type) If yes, give date D. LIFT STATION N - h. Date installed Size in gallons 'Pump on" level at _ in. "Pump ofr level at _ in. Datum Cycles tested Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuU requirements? in. E. SEPARATION DISTANCES noot 4 ,e r'Ftrct' 4 rA t, rid SEPARATION DISTANCES FROM WELL ON LOT TO: no w����JstydCcQ , Septic tank/lift station on lot — On adjacent lots — Absorption field on lot "' On adjacent lots — Public sewer main SG Public sewer manhole/cleanout > tOG ' Sewer /septic service line ;Z� J 3 1 Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: t4,4. A / Uu Se tier, 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: AJ. A. Property line Building foundation Water main Water Service line Surface water Driveway, parkinglvehide storage Curtain drain Wells on adjacent lots F. COMMENTS S fruA Ar/4/7c&, tsIere l< al ctnd /or noot 4 ,e r'Ftrct' 4 rA t, rid r well w c(rrflwcf to no w����JstydCcQ , G. ENGINEER'S CERTIFICATION At%', -e I certify that I have determined through field inspections and �......XT - •• review of Municipal records that the above systems are in l Tid��� conformance with MOA HAA guidelines in effect on this date. • ; -, ,' �� . �� Engineer's Printed Name Th �u clo�r� F. M�a� ....:.. .:....... o : THEODORE F. MOORE Al Date March 2 U� 2G0 3 .„'., CE -3589 l� HAA Fee $ 3 7S- --'fa Date of Payment ?I Z t `03 opQ Receipt Number �Zo (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number Al fi,.)' (Ir)• .". rn z A/ 09- 1:191 sc' vi a p K //a I horoby esrlify that a survey of the foliowlnq descrlhed proparly Lot'' ��'��(S/„esu xat mada on a1-=—�jc_-�)-/Z 7P,4nd That the •Jmprovemtnls altuatod thuaon ote eltttln I. a proporly )Iner Ond do not Ovprlop or oncroaah on (ho property odjocenl t1eralo I that no Improrsntenta on propefly lying idfa:Ihf thststa aoer000h an the Mrnlsaa In quolflon and thal there ort na Toodraya, Ironemisalon IIn41 or other vi:IDls oatonanlo on soh propotly altetpl of hillestad hereon. Doted at Anonordgii. Alosla, this /H day of COCTAC MG G.10=M A A330V. hilarnaflarlol Alrport ttood Ancl>crorl I All ska DO= Panna: 270-•3773 I t n a�F'A w.✓: �; ��. . •�,�� OF q�gia� ••,iiy,.•gi a.•.t•gta•t. i•• • d r• Aa.�h t. 1e'acln t a �' N0. 3001•S tl; lOo •..ae.•• "Ob ” SEAL ' t .h 4o, r Cx/ori err M � J •C p � � sr •art rn z A/ 09- 1:191 sc' vi a p K //a I horoby esrlify that a survey of the foliowlnq descrlhed proparly Lot'' ��'��(S/„esu xat mada on a1-=—�jc_-�)-/Z 7P,4nd That the •Jmprovemtnls altuatod thuaon ote eltttln I. a proporly )Iner Ond do not Ovprlop or oncroaah on (ho property odjocenl t1eralo I that no Improrsntenta on propefly lying idfa:Ihf thststa aoer000h an the Mrnlsaa In quolflon and thal there ort na Toodraya, Ironemisalon IIn41 or other vi:IDls oatonanlo on soh propotly altetpl of hillestad hereon. Doted at Anonordgii. Alosla, this /H day of COCTAC MG G.10=M A A330V. hilarnaflarlol Alrport ttood Ancl>crorl I All ska DO= Panna: 270-•3773 I t n a�F'A w.✓: �; ��. . •�,�� OF q�gia� ••,iiy,.•gi a.•.t•gta•t. i•• • d r• Aa.�h t. 1e'acln t a �' N0. 3001•S tl; lOo •..ae.•• "Ob ” SEAL -1) SL v 5. LEGAL DESCRIPTION DATE RECEIVED y7 INSPECTION APPOINTMENTS Subdivision TIME TIME TIME 6. TYPE OF RESIDENCE DATE DATE DATE Rk SINGLE FAMILY XX Two ❑ Five ❑ MULTIPLE FAMILY INSPECTOR INSPECTOR INSPECTO MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION FEB 2 5 1981 Telephone 264-4720 depth (attach log if available.) pp ���^^ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE�IO(fil11V1h0 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 00) days for processing. 1. PROPERTY OWNER Lester P./Dorothy M. Mann YEAR ON-SITE SYSTEM WAS INSTALLED. PHONE 243-6568 MAILING ADDRESS - 2304 Turnagain Parkway 99503 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER Roman P./Kelly P. Mann—Frank PHONE 279-8989 MAILING ADDRESS 3006 Eureka Street 99503 3. LENDING INSTITUTION PHONE Alaska Pacific Bank 276-3110 MAILING ADDRESS Post Office Box 420 99510 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION Lot 2 Block 3 Calais Subdivision STREET LOCATION 3906 Eureka Street 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other Rk SINGLE FAMILY XX Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY KX INDIVIDUAL* 112' * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. K3< PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) w.", THIS SIDE FOR OFFICIAL USE ONLY ` 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS Ci—APPROVED FOR Z— BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 72-010 ( Rev. 6/79) 825 ST FIEET ANCHORAGE, ALASKA 99501 (907) 264-4111 -4 L. -O a_[ - GEORGE M. SULLIVAN, P0 A Y 0 P, 1) E PAR7 N1 E NT O 1: HEALTH AN D E N V I R ON M UNTA L PROTECTION March 9, 1981 Lester P./Dorothy M. Mann 2304 Turnagain Parkway Anchorage, Alaska 99503 Subject: Lot 2 Block 3 Calais Subdivision Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report needs -to be delivered to this office from the Chem Lab, 5633 B Street, for our review. (2) Expose the well for our inspection to determine proper construction. Please call this office for another appointment. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC,. Alaska Pacific Bank Post Office Box 420 99510 Roman P./Kelly P. Mann -Frank 3006 Eureka Street 99503 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION_ /825 L Street - Anchorage, Alaska 99501 • ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER f�� [ PHONE MAILING ADDRESS 3c,oc t4 e PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE -2- MAI LING ADDRESS _ 3. LENDING INSTITUTION , PHONE —77 MAILING ADDRESS 4. REALTOR/AGENT PHONE A MAILING ADDRESS / rN 5. LEGAL DESCRIPTION STREET LOCATION S71 // 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS FAMILY ❑ One ❑ Four ❑ Other SINGLE 9 Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ® INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ` / ❑ PUBLIC UTILITY depth (attach log if available.) 09 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required Igl PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY r INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER l ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS fI�—­APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certific ❑ DISAPPROVED te) DATE / BY itle) LEGAL DESCRIPTION 72-010 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE .Department of Heald; and Environmental Protection r�• -'►��� 825 L Street, Anchorage, Alaska 99501 t l 264-4720 =i2quest for Approval of Individual Sewer and Water Facilities 1. Property Owner: Lester P. and Dorothy M. Mann Mailing Address • 3006 Mailing Address • 2304 Turnagain Pkwy, Anch. , Ak. 99503 Phone: 243-6568 2. Name of Buyer • Roman P. Frank & Kelly P. Mann -Frank Mailing Address • 3006 Eureka Street, Anch. , Ak. 99503 Phone : 279-8989 3. Lending Institution: Alaska Pacific Bank Mailing Address • P.O. Box 420, Anchorage, Ak. 99510 Phone: 276-3110 4 . Realtor/Agent : none Mailing Address: _ Phone: 5. Legal Description • Lot 2, Blk. 3, Calais Subdivision Street Location: 3006 Eureka Street 6. Single Family Residence: (x) Number of Bedrooms: 2 Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well (xx) Public/Community System ( ) If Individual Well, well depth 112 feet (drilled in May of 1975) If Community System, name of system 8. Sewage Disposal System: 'On-site System ( ) Public System Ax) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be iniLiaLcd. 3/77 • 'Rus: 271:2501 Res: 27 #-0173' Urngard DAVID A. ROGERS Agent Urngard Olympic Life insurance Company 206 YY. Northern Lights Blvd. • Anchorage, Alaska 99503 I 10 01 700 06-04 04-600 ; 506 i (50z ! 2501 i , �Il 06 204 2DN 106 10-1 BBBB 2807 I _ 1801 2905 2.861 1805 II 1005 I I , 1 2808 i 1910 's 1805 B � Cf) 1H07 <808 �`_��8 i 2601 � ua7 1 � " r C r ?.8zo u07 2aos- 2 06 01 700 j 7 e 1 21 22 ,2900�l6 9a 2013..._._.- Z403 2902 M k5- toi �Iql 1! 4 2963 y24oN 74041 ! 2405 21oY 11 1/8 Z5 r 1406 �- 2405 290 f1107 1407 S 2906 11 r7� 4 1408 2110 32904 290! 1 2909i�1466 ,109 01 �43 2 /3 r6. Zj� 44.10! L.. 11141/r _,24/0 !3911 i �1. _ 1 ��151.1$ -� 421 Y7 !yq 3e Si•S6 SY 331,3E 3r 301,29 001 3060' Lr7 - 1 , 3001 ' I (3001 z9rz # PARK PL. 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W. 33 AVE. 0 F 3315 3300 Ce 330Z - 3401 30E3401 F S26S taoute 3300> _, 310 240 - 1,60 25A n !30" 3302 2460 M N 8 ui Cr330'► 3305 t !g4 �1►rr I T�"„ Illi fi 3374 37o M t 0x:6 ' 3321 Uj� 3314 13315 y 0 _ M wi O I v,. 3'x4 t I 3321 13313 } 3(111 M M M , a 334 'a 3v5 ---- 35S � W s 4- P t Ul I 3101 V00 j W! u 3488 I , 64 Spenard Area Reference Map -P7 76 -QC&>- 78 Y 88 cl '6 'illJ1i 77