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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
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#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.
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Insulation ❑ Cieanouts Type
Connect Agent Inspector Date
Comments
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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'
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K
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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
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A/ 09- 1:191 sc'
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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
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a�F'A w.✓: �; ��. .
•�,�� OF q�gia�
••,iiy,.•gi a.•.t•gta•t. i•• • d
r• Aa.�h t. 1e'acln t a �'
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SEAL
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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
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77