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Home My WebLink AboutALPINE WOODS BLK 5 LT 8 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S/d/ 950/7~-~ PID Number: 0/~ ~-:~/-/' ~-~ N.m~:Wastewater System: ~New ~ Upgrade Address: (~ /~?/~ ~5, ~/~ ABSORPTION FIELD Pho~:~ '~/~ ~~ I No. of Bedrooms:~ ~eep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other Total Depth from original grade: LEGAL DESCRIPTION SoilRating: ~, ~ GPD/Sq. Ft. /~, ~ ' fro~inal Block: Subdivision: Depth to pipe ~ottom grade: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: ~ Ft. Ft. WELL: ~ New ~M~_. ~ ~ U pg rade Gravel ~ Number of lines: Distance ~tw~n lines: Classification (Private, A,B,C): Total Depth: ~ Total absorption area: Pipe material: ~c Driller: Date installed: / ~/~~te Drillee: Stabc Water Level: Installer:~ . ~ Yield:/~GPM I~ump s°t ~': ~,. [ Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ; s~pti~ ~ Holding To Septic Absorption Lift Holding ~/Private Manufacturer: Capacity in qallons: Number of Compadments: Well ~/~ ~/~ ~ Material: S~;~ Sudace Wa~e~ N/~ ~ LIFT STATION Lot , , Line ~/~ ~/~ ~/Dt Size in gallons:IManufacturer: "Pump on' level at: ] "Pump off" level at: ] High water alarm at: ~o~n~a~on ~ ~/0' +~ ' ~/~ ~9"~ y~"~ ~" Cu~ainDrain ~/~ > ¢~ Uake ' U°de/ I Bectrical 'ns~ecti°ns ~ed°rmed bY:~o ~ Re~ar~s: ~~ ~~ ~ "~ ~.~,_~ BENCH MARK Location and Description: Assumed E~evation: Inspections pedormed by: ~/Z~Z Dates: 1st ~;/75 ~ - ,~ ¢. ~ LOUIS ~. ~u,er~ 2nd ~?//~/~5 ~ ~. .' Department of Health and Human Services approval '~.'*~-'..~ .......... Reviewed and approved by: ~ ~ Date: ~ -/~-¢~ t 72-013 (I/91) MOA 25 Permit No. ~.~'l,~/ '-~.~(.21/-.~ Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 345-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ALPINE WOODS LOT 8 BLK 5 PID No.: ~/~' 2'..~ -~P? HUFFNAN RDAD · - MONITOR ~8E - S~ER CL~NOUT o + - K~BOX ~ - L~CHFIELD ~SEMENT - WATER ONE ELEVATIONS (NOT TD SCALE) ~ ENGINEER'S SEAL --- ~/~.~ ~ ......................... ] ....... PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950125 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:DUHR DONALD F (27.3%) OWNER ADDRESS:6050 ALPINE WOODS DR ANCHORAGE, ALASKA 99516 DATE ISSUED: 6/20/95 EXPIRATION DATE: 6/20/96 PARCEL ID:01523438 LEGAL DESCRIPTION: ALPINE WOODS BLK 5 LT 8 LOT SIZE: 44810 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: LEGAL: SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM R [ C [ IV E D Alpine Woods Lot 8, Block 5 REVISED 06/28/95 2. 3. 4. 5. 6. 7. 8. JUN 2 9 19,.35 Municipality o1: Anchorage Dept. Health & Human Services The septic plan is for a single family residence only. The drawing and or site plan shall be a part of this specification. All materials and workmanship shall meet the Anchorage Department of Health requirements. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 13' at any point. 4. The trench gravel is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 6. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 7. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. ~ECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 13' GRAVEL DEPTH = 10' under pipe, 2"over pipe TRENCH LENGTH = 40' TRENCH WIDTH = 3' SOIL RATING = 0.8 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK = 1,500 gallon minimum with lift MOA approved. EFFLUENT PIPE = 1-1/4" HDPE SDR-17 or better, transition to PVC at field. Twenty-four (24) hours notice required for all inspections. Colony Builders, B.Taylor MOA-DHHS, D.Roth G:\WPDOCS\1995\95-O20B.SPC EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 95-020 Calculated By: LB Date: 6/28/95 Single Family 4 Bedroom Dwelling Deep Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = Percolation rate = Wastewater application rate = Required absorption area = Trench width (W) = Gravel depth (D) = 600 gallons 16 minutes per inch 0.8 gallons per day per square foot 750 square feet 3 feet 10 feet Required length = Required absorption area / 2 / D Required length = Required length = Total Excavation Depth Pressure lateral hole spacing 1/8" orfice 25 GPM/0.42 GPM per hole = 60 holes Spacing = 40'/60 = 8" 750 / 2 / 10 38 feet 13 feet UNSUB]%ViDED NOTE~ WATER LINE MUST BE 10' FROM REPLACEPIENI SITE TRENCHES, NO SURFACE WATER NO KNOWN CURTAIN DRAINS [] - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT ~,- - KEYBOX PROPOSED LEACHFIELD EASEMENT - PROPOSED WATER LINE SEPTIC SITE PLAN LEGAL: ALPINE WOODS LOT 8, BLK 5 OWNER' CONTRACTOR' COLONY BUILDERS JOB // 95-020 DATE' 6/28/95 SCALE 1" - 60' EAGLE RIVER ENGINEERING SER VICES A P.O. Bom 7732,94 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 Lotlis Butera, ?.E. Registered Civil Engineer June 9, 1995 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Alpine Woods Lot 8, Blk 5 Narrative & Permit Application Dear Mr. Cross: The proposed septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, and have community water connection allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all + 30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \G: \WPDO C S\ 1995 \95 -020A. N AR P.O. Box 77:3294 · Eagle River, ,Alaska 99577 · Telephone (907) 694.5195 · Fax 1907} 694-3297 LEGAL: SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM Alpine Woods Lot 8, Block 5 06/09/95 Bo 1. The septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 1. The trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 14' at any point. 4. The trench gravel is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 6. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 7. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. i~ECOMMENDED I JEACHFIELD DIMENSIONS: TOTAL DEPTH = 14' GRAVEL DEPTH = 6' under pipe, 2"over pipe TRENCH LENGTH = 83' TRENCH WIDTH = 3' SOIL RATING = 0.6 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK = 1,250 gallon minimum MOA approved. NOTE: Lift station may be required to provide effluent delivery to leachfield. station is needed, MOA code inspection will be required. If a lift Twenty-four (24) hours notice required for all inspections. G:\WPDOCS\1995\95-020A.SPC NO WELL SEPTIC +30' t250 GAL TANK NO WELL SF~.F'TI C +30' i0' UTILITY EASEMENT 15' EQUESTRIAN EASEMENT HUFFMAN ('o ROAD UNSUBDIVIDED NOTE: PRIMARY SYSTEM GRAVEL DEPTH & ORIENTATION MAY BE ADJUSTED TO MEET THE HOUSE FOUNDATION DEPTH, ~ATER LINE MUST BE 10' FROM REPLACEHENT SITE TRENCHES. LIFT STATION MAY BE REQUIRED, NO SURFACE WATER NO KNOWN CURTAIN DRAINS SEPTIC SITE PLAN LEGAL: ALPINE WOODS LOT 8, BLK 5 OWNER: OLAUGHLIN/DUHR CONTRACTOR: COLONY BUILDERS JOB# 95-020A DATE: 06/09/95 SCALE 1" = 60' EA CLE RIVER ENGINEERINC SER VICES A P.O. Box, 7732,94 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 [] - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT + - KEYBOX PROPOSED LEACHFIELD EASEMENT - PROPOSED WATER LINE EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERE$ Project No.: Calculated Ry: LB Date: 4/4/95 Single Family 4 Bedroom Dwelling Deep Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 Percolation rate = 16 Wastewater application rate = 0.6 Required absorption area = 1000 Trench width ON) = 3 Gravel depth (D) = 6 gallons minutes per inch gallons per day per square foot square feet feet feet Required length = Required absorption area / 2 / D Required length = 1000 / Required length = 83 feet Total Excavation Depth 14 feet 2 / 6 SINGLE FAMILY ON-SITE WORKSHEET ERES PROJECT NUMBER: 95-020 LEGAL DESCRIPTION: ALPINE WOODS L8 B5 NUMBER OF BEDROOMS: 4 WATER USE PER BEDROOM: 150 PERCOLATION RATE: 16 DEPTH TO GROUNDWATER: 20 DEPTH TO IMPERMEABLE LAYER: 20 MINIMUM DEPTH OF COVER: 3 MOUND OR BED SYSTEM WASTEWATER APPLICATION RATE: ABSORPTION AREA REQUIREMENT: MINIMUM BED LENGTH 12 FEET WIDE BED 15 FEET WIDE BED TRENCH SYSTEM WASTEWATER APPLICATION RATE: ABSORPTION AREA REQUIREMENT: SHALLOW TRENCH OPTIONS 5 FEET WIDE TRENCH EFFECTIVE REQUIRED TRENCH DEPTH (FT) LENGTH (FT) 1 175 2 140 2.5 127 3 117 3.5 108 4 100 CALCULATED BY: LB GALLONS MINUTES PER INCH FEET FEET FEET 0.45 1333 USABLE SOIL STRATA TOTAL USABLE DEPTH: 14 USABLE SOIL STRATA DEPTH: 1 1 GAL/SQ,FT SQ.FT 111 FEET 89 FEET RECOMENDED DESIGN FIELD SYSTEM: GRAVEL DEPTH: TRENCH OR BED WIDTH: LENGTH: TOTAL EXCAVATION DEPTH: D 6 3 83 14 0.6 1000 GAL/SQ.FT SQ.FT DEEP TRENCH OPTIONS 3 FEET WIDE TRENCH EFFECTIVE REQUIRED TRENCH DEPTH (FT) LENGTH (FT~ 4 125 4.5 111 5 100 5.5 91 6 83 7 71 8 63 9 56 10 50 (B=BED, S=SHALLOWTRENCH & D=DEEP TRENCH) FEET FEET FEET FEET PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Township, Range, Section: SLOPE GROUND WATER :OUNTERED? N'O S L AT WHAT O P E ~ ~ r~ o.,- q/~/~- SITE PLAN \ \ \ Gross Net Deoth to Net Reading Date Time Time Water Drop 3 " I]; /~ t~-~'' ~' ~" RATE //'/' (mlnute~,nch) PERC HOLE DIAMETER TEST RUN BETWEEN '~' FT AND ~',.t' FT ,~ " c::/,C' ,' ~'o ' COMMENTS PERFORMED BY: ~::,/~.~.C · I ~"~"'~~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; 72-O08 (Rev. a/85) PERFORMED FOR: Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 g 10 11 12 13 14 15 16 17 18 19 20 /L ~ ~ WAS ( ENCC IF YE DEPT Monitofi~ '~/ PERC Township. Range, Section: SLOPE SITE PLAN GROUND WATER INTERED? ;, AT WHAT ~th to Water After ~/j/.~- S L O P Gross Net Depth to Net Reading Date Time Time Water Drop ~,1 DN RATE __ (m,nutes~lncnl PERC HOLE DIAMETER TEST RUN BETWEEN 6 FT AND '~ FT COMMENTS PERFORMED BY: ~c:,/~.~,.~.. I '~"""~~~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. 72-008 (Rev, 4/85) OERTIFY THAT THIS TEST WAS PERFORMED IN FILTER 5/8" REBAR MARKER FINISH GRADE C> o x° o% o o FABRIC o 0 0 0 0 ~~1-1/4" 45" EL ~O ~°0 OoO O ~lz2~6AL END PRESSURE CLEANOUT DETAIL LEGAL: ALPINE WOODS LOT 8, ELK 5 OWNER' N/A CONTRACTOR: COLONY BUILDERS JOB// 95-020A DATE' 06/28/95 NOT TO SCALE EAGLE RIVER ENGINEERINC SERWCES A P.O. Box 773294 EAGLE RIVER, AK. 9~577 (907) 694-5195 FAX: (907) 694-3297 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~,\JD- '-~. %~-~- "~-"~ HAA# ~.~\~,c-~ .¢} (_-.;.~-~L! .~. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC a!fest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 ,iRev 1/91) Front MOA #21 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 of this Health Authority Approval application 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. ~E: .:.: ,-,~; ;:~¢,,,c:~ Phone Name of Firm ': ..". ;'J'~3r ~:.:~ 995.-7. Engineer's signature _.-¢:; .¢-~___ ¢~ Date DHHS SIGNATURE ,~ Approved for , Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipali~ of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates 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 Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72A325 trey 1/91) Back MOA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist Legal Description: ~,~/~ /5~/./F X'- ,4/~,,,2e t.,a,,o~e.x Parcel I.D.: ~9/~;- - ~. A. WELL DATA Well type /9, g,/, ,.. If A. B. or C, attach ADEC letter. ADEC water syste~n number Log present (Y/N) ,,//,4- Date completed Total depth Sanitary seal (Y/N) Cased to Date of test Static water level Well production ,~ g.p.m WATER SAMPLE RESULTS: Coliform Nitrate ollectcd by:~ Other bacteria Date of sample: C . Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION in: B. SEPTIC/HOLDING TANK DATA Date installed ~//9.3- Tank size /5-oo.~,, ~. Number of Compartments ~, Cleanouts (Y/N) / Foundation clcanout (Y/N) / Depression (Y/N) ,fLY High water alarm (Y/N) Date of Pumping ,~/.~ ~,~o,2 Pumper .~/.~ C. ABSORPTION FlELD DATA Date installed ?/gj- Soil rating (g.p.d./ft: or fi-'/bdrm) ~>, E: System type t' Length z-/~> / Width ~ / Gravel thickness below pipe / 6> Total depth /3, Effective absorption area gc>o ~i/¢ Monitoring Tube present(Y/N) Y' Depression over field (Y/N) m) Date of adequacy test zw~ow Results (Pass/Fail) For ~ bedrooms Fluid depth in absorption field before test (in.): -- hnmediateh, ,after -- gal. water added (iu.): -- Fluid depth ~ .(ins.) Minutes later: Peroxide treatment (past 12 months) (Y/N) Absorption rate = If yes. give date .g.p.d. D. LIlT STATION Date installed 7/'~ S"- Manhole/Access (Y/N) fi/ High water alarm level at* Size "Pump on" level at* O'O' "Pump ofF' level at* *Datum Cycles tested ,-',/,a (",,, e ,-,-) E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ,,~,,~ /o. ~,/, ~ ~ ~ · On adjacent lots /'~?,~ Absorption field on lot Public sewer main · On adjacent lots '-' ,/.a Public sewer manhole/cleanout '",'~ Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /.5- / Property line 5--o Absorption field Water main/service line ..23" ' Surface water/drainage r/var Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ...25-- / Water mare/service line K'~ ' Surface water /-/va ' Driveway. parking/vehicle storage area ,.5--3-/ Curtain drain ,w/.a Wells on adjacent lots t- a.,,~, ' Propem.' line Engineer's Name ,~, r.> /_.~ ,4~ ,-~ Date //- -z ~ - 5'$- F. ENGINEER'S CERTIFICATION ~ · .: I certi/.i~ that I have determined thru field inspections and review oj'A~lunicipal recor~14' 'th'at the above ~ste~e m con/brmance with MOA IL~ guidelines in effect on this date. , ~ ': Signature ~;~ ~. ',~meeri~ Seal ~ere: ............................................................................................................................................ HAA Fee * '.~ [)5~) , fiT.) Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Rex,. 8/95 OSS: haa.wk.doc NOU-22-1995 15:44 COLONY BUILERS, INC. P.O1 : ,.,. .... ... M'UNICIP~LI~Y .UZ ANCHORAGe. BUILDING S~g'~Y. DIVISION ......... ,': ,';:.', '" ' 3500 EA9~ .TUBO~,ROAr~ .... . - ' ~ ', [NEORHATI~tN: I~EC~IONS: (.907) 5~3~34&4 ' ' .' ~HE: COLONY gu ;~S: 6050' A(.PT.N~ ~oOX~ ~k · DAT~: 11/2~/95 ~T: 8 BLOC~: ~ SIJBDI~IS[ON: AT. PTN~ WOOD NSP£C]:OR :" '_ __ ,,~.~_ ~" _.. WH~.N.CORI~.CTIOHS AI~t; HAit}:- ~t-flTM brand fax tm;smi,~ memo ~ ~.?.,,~,~ _ _ i TOTAL P.01