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Home My WebLink AboutSKYWAY PARK ESTATES BLK 8 LT 4kyway Park Estates Block 8 Lot 4 #019-201-07 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. RETURN TO Division of Geological and Ge rlcat Surveys (OGGS) 3001 Porcupine Drive (Telephmw: 277-6615) Anchorage, Alaska 99501 W A T E-9 W E L L R E C O R D or l l ling Company Me. _VernS ri Or.ATION OF WELL Please complete either la, It, or Ic. U.S.G.S. Local He. Drilling Permit No. A.D.L. No. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES Ia. Borou h Subdivision lo�t�Rlock Ib. Fraction Section No. Township Range Meridian An N. Skyway L_� / / lo- Distance and Direction from Road Intersections 3. OWNER OF WELL: Wilbur E. Bline Address: 121 E. 92nd Ave. Street Address and Area of Well Location Anchorage, Ak . 99502 2. WELL LOG --_ Feet Below 4. WELL DEPTH: (completed) Surface Elevation Dat70f _Surface �7 Com Material Type -Top DO ttom f 2 f�-- ' �..._._.�_ S1 e1yray-brown 0_ ^0 v 5. I%I cable tool Rotary Driven Dug Auger ❑Jetted ❑Bored ❑Other. hard fan _ -- gown hard silt boulders �( 6. USE: IDo _•stic Public SuPPIY Industry Dirrigatlon ❑Recharge ❑Comelerc in Test Well ❑other: _-- —'— —Threaded — CASING: I Hclded to _7% ft. Depth Weight `- lbs/ft. in. to ft. Depth gravely bouldersto -37- a2 Z '3Z_ silty gr vel. �— 5a sane &gravel _seepage 52 57 grayy--�sill_ san�ravel -ISI— _52� _'lQ _— —c— — 8. FINISH OF WELL: TYPe: —----®--.•^ open end Diameter: 61t Slot/Mesh Size: _ Length: — Set between - ft. and ft. Fittings; — --_-_-- -------^ -�'-- 9, STATIC WATER LEVEL: ft. Above ❑Below land surface Type of Measurement: t0 of Casing — —^ ----- _—e_ -- -----•---�-- — '"----` 10. PUMPING LEVEL below land surface 1 ft. after hrs b¢Ump�rtg9-P.M. _ _ ft, after hrs. pumping --• g.p.m. ----_--- ®se.00__.iaca{--l-w--j •— II. WELL HEAD COMPLETION: In Approved Pit [] Pltless Adapter _—,inches above grade p — — � — 12. GROUTING: Well Grouted: 0 Yes LIN- INPMaterial: CINcat Cement CI Other: material: ---e— 13, PUMP: (If available) HP _-- Length of Drop Pipe ft. capacI ty 9.P Type: ❑ Submersible OReciprocating ❑Jet ❑Other: ^, -- ----- ------- ---�""---- -__----p�-- 14. RENARKS-�f'—.-- Water -Temperature: s ------- 15, 'WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this report 15 true to the best of my knowledge and belief: Vern's Drilling & Ent. AA 3327 _ i Registered Bus-ness NamaName— Contract License Number Address, SRA Box 1560 Anchorage, Ak Signed:_ — Date: Authorized Aepre se motive Form 02-WWR Copy Distribution: WHITE - State DGGS, PINK - Driller, CANARY - Customer IF A20 X ��k FA 17) FIT f 7� I'_:: l! - 11 i�. � F, il C: LL�� DEPRRTMENT OF HEHLTH HND ENYIRONMENT8L PROTECTION 825 'L/ STREET, ANCHORAGE, HK, 99301 264~472(j 84 K t.. L. �K Tito-! I "T - PERMIT NO. ( 820017 ) / APPLICANT- WILBUR BLMNE 1212 E 92 AVE I44-6648 LOCATION SHORE DR LEGHL LOT 4 BLK 8 SKYWAY S/D LOT SIZE 67300 SQUARE FEET �� A(�JL| 0\ �a A-) MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM R PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AMC, TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY:., OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. �90"TEVI x IT- FREE15 �:1 �� I CERTIFY THAI 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. RPPLICHNT WILBUR 8LHNE ISSUED BY.- V4.0 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 nc^ S S S�nwww.cl.anchorage.ek.us `0. GQ (907) 343-7904 J CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. (-! 2t HAA# _ C5() ;?L? ( 1. GENERAL INFORMATION Expiration Date: _9 " 18 — d .57' Complete legal description SKYWAY PARK ESTATES SUBDMSION• LOT 4 BLOCK 8 ❑ Individual Holding tank ❑ Community Class Well Location (site address or directions) 1200 SHORE DRIVE • ANCHORAGE. AK 99515 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address GARY AND KATHY HOUGHTON Day phone 248-6067 1200 SHORE DRIVE • ANCHORAGE AK 99515 Day phone ROY BRILEY w/ DYNAMIC PROPERTIES Day phone 279-2911 3111 'C' STREET • ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 0 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 samples. (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 seat 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 onsite 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. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis ofthe system In accordance with ADEC and MOA DSD Guidelines B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readilyidentitiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for Me sole benerit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for _-L�— bedrooms. Disapproved. Phone 337-6179 Date 48 IS - Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineers Report Other V ' ON-SIIE—, cs WATER AND :-;AIASTE�NATER-; PROGRAM By. r;Lr//�C1' �l Original Certificate Date: - U (R". 12J01) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Sregsw St. P.O. Box 198850 Anchorage, AK 9951944 www.c.anchorage.sk.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Oescriptlon:SKYWAY PARK ESTATES SUBDIVISION: LOT 4. BLACK 8 Parcel ID: 0191 A. WELL DATA Well" PRIME If A, B, or C provide PWSID# NIA Date completed 1982 Sanitary seal (YM) YES Total depth 72 ft. Cased to 72 ft. FROM WELL LOG Date of test 1982 Static water level 49 ft. Well production 15 O.P.M. Well Log (Y/N) YES Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 5/9/2005 50 ft. 8.9 g.p.m. WATER SAMPLE RESULTS: Colform colonies/100 ml. Nitrate 0.10mgA. Other bacteria colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 5/9/2005 Col)ected by: GEG. Ltd. S. SEPTIC/HOLDINGTANK DATA PUBLIC SEWER Tank Type/Matartal Date Installed Tank sine gal. Number of Compartments _ C�anor"fa Foundation cleanout (Y/N) High water alarm (YM) DaweFp jng Pumper C. ABSORPTION FIELD DATA PUBLIC SEWER Date Installed Soil rating (g.p.dAix ft%dnn)_ System type Length ft. Width ft. Gravel below 0'pa/ ft. Totel depth ft. Eft. absorption area— fe Monitoring tube Depression over field Date of adequacy test ResultsLeaes;T-8G) For—bedrooms Fluid depth in absorption Held be tet! h. Water added _gal. New depth —in. Elapsed Time. ff" Final fluid depth _ in. Absorption rate >= g.p.d. uvenatlon treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at Cycles tested Meets alarm b circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field an lot N/A Public sewer main 50'+ Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 50'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption Water main Water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line F. COMMENTS 0. ENGINEER'S CERTIFICATION Building foundation Water Surface water Wells on adjacent kits I ceR(ty that I have detemdned through held aupections and *!• review of Municipal records that the above systems are In ... conformance with MOA MAA guidetlnes in effed on this date. W. Engineer's Printed Name JEFFREY A. GARNESS Date HAA Fee E 4,24 C) Date of Payment 5�1 Receipt Number�t�4-0i IR*V. laroi► Waiver Fee $ Date of Payment Receipt Number water storage ............... Fay ess! CE -7953 .•' �e� .... 5-16-05:10:01AM: E bl CS Ret# 1052463001 Nent Name Garncss Engineering Group, Ltd. 'rojeetName/# Various Tent Sample ID Skyway Park Est S/D, Lt 4 Bk 8 Istri= Drinking Water ample Remarks: :807 6615301 All Datesfrimes are Alaska Standard Time PrintedDateRime 05/13/2005 8:42 Collected Date/Time 05/09/2005 13:22 Received Daterrime 05/09200514:30 Technical Director Stephen C. Ede • 2/ 6 Allowable Prep Analysis atametcr Results POL Volts Method Containcr 1D Limits . Date Date snit 'atera Department Nitrate -N 0.100 U 0.100 licrobiology Laboratory Total Coliform 9 OB. No Coli mg/L EPA 300.0 B (o-.10) 05/09/05 JJB c01/100mL SM209222B A (o-1) 05/09/05 TLF W Municipality of Anchorage �� Development Services Department C� a Building Safety Division ' On -Site Water & 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. 019 � } HAA#L433 I. GENERAL INFORMATION _— Expiration Date: 0 Complete legal description SKYWAY PARK ESTATES SUBDIVISION- LOT 4 BLOCK 8 Location (site address or directions) 1200 SHORE DRIVE * ANCHORAGE AK 99515 Current Property owner(s) WILBER BINE Day phone 344-6648 Mailing address 1200 SHORE DRIVE * ANCHORAGE AK 99515 Lending agency Day phone Mailing address Real Estate Agent F.S.B.O. _ Day phone Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Water Storage Community Class Well Public Water System Q Individual On-site Individual Holding tank Community site Public Sewer El El ■ 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 samples. (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 t my As certified by my seal affixed hereto and as of the validation date shown al Guidelines fobelow, I verify r this application, investigation, based on procedures outlined in the Health Authority App 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 furthernve verify and inspection, the t based on the information obtained from the Municipality of Anchorage files and from my ' 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. ----- Phone 337-6179 507 Address 3701 E. TUDOR JEFFREY A. GARNESS, P.E. SUITE 101 Engineer's Printed Name AK 99 Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the The content this report operational requirements of the ADEC or MOA DSD. rfor t the sole benefit of the owner listed above. Any reliance upon g usea of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE SIIGNATURE 111 A roved for _-4— bedrooms. Date PP Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: `,`,ttt�Y(OF,Q �ry�/ice/� Q ' •. O�� -,qa' WATERAND ' m- WASTEWATE Attachments: Manitenance Agreements HAA Checklist Supplemental Engineer's Reort ----- Septic System Advisory Other Well Flow Advisory 3 C Original Certificate Date: By: (Rev. 12101) Municipality of Anchorage ' w 11 Developmht Services Department Building Safety Division On Site`Water & 1"�Uastewa - Program �` K Sn TY kSouth ragaw St x ox 18'6650 A hc}iorage, AfC99519=8650 ��c"�anc`horage ak:us Y C �� `;HEALT,H AUTHORI7�"'"wAPPRC7VAL CHECKLIST Ia esci•iption; L 4 BCbCK�B�"�pa"reellD:" "019 ` e pRiv^Te ' lfA; B ori pr'owde PWSIb# N A � •�� • �" �• °completed " 1982 _,.Sanitary seal (Y/N YES ` " "" ' •� �� Cased to 72 " ft; `� �Casing^height (above ground) 12+ in.� �.. ,. AT! e o",test 1982. $/17/2004" !c water level 49 ft production 15 N, g.p m38g.p.m. colonies/100m1 Nitrate"_ .. aOther-bacteria_ " JL...,.,u colonies/100 m1. ue: ' /A mg•/L• Date of sam le: $ i7 2004 '' °� p Collected by: �' 'SEG, Ltd: 0 Date installed >lze gal Number of Compartments cl anon cleanout(YfN) D ertank —777Rr water Marrs (Y/N) tng Pumper —mow Soil eating 41), a /ft`or fQbdM S ystem type _ i4Ew erP-..4.re nY.+r ------�ft•� Width Gravel below p ft Eft adsorption area" ftz, Monitoring be Dere W p ssion over field ac(equacy test Resulfs `�'" -ail) For --.._bedrooms pthm absorption fieldeiore st!n Water added= gal New depth in Firiafftui'de'pth m. Absorp{ion rate >= cycles tested_ ., _in. High water alarm level at in. __---- Meets alarm & circuit requirements? _ ... determined through field mspeG_ ons and _.. J records that the above systems are in MOA HAA guidelines in effect on this date O eff y A. _ ss: w me ilEFFREY A GARIJESS QQ °� C .... 7953 ,omG r 4�Vre°e o Na� dprofessYoo 6-27-04; 9:47AM; ;907 56[5301 ;GS Ref.# 1045224001 :lient Name Garners Engineering Group, Ltd. 'roject Name/# :tient Sample ID Lot 4,13k 8 Skyway Park Est Lot 4, Bk 8, Skyway park Est Ratrix Drinking Water ample Remarks: aramcter Results PQL Units latera Department Nitrate -N 0.1001U licrobiology Laboratory Total Coliform TNTC OB All Dates/Times are Alaska Standard Time Printed Date/Time 08/23/2004 Collected Date/Time 10:31 08/17/2004 9:01 ReceivedDate/Time 08/17/2004 11:20 Technical Director Q'Stenh C. Ede Released 0.100 mg/L EPA 300.0 c01/100mL SN U0 9222B ContainerlD Allowable Prep Analysis Limits Date Date Init B (<-10) 08/17/04 BB A (<-1) 08/17/04 DKC — vr; 1:37 ;CT a,d E AW c SGS/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER El PUBLIC WATER SYSTEM ION *] PRIVATE WATER SYSTEM 5615301 # 2/ 200 W. POTTER DRIVE ANCHORAGE, ALASKA 9951a Tel: 907-562-2343 Fax: 907-581.5301 1045224-1 Ilellllllll�n femm�l lna en.wuun Y t• Ij Send Results I b Send Invoke SAMPLE COLLECTION: mub..n.Mb mun InM W"h/�n�I M•tlbn. ((''5-1 Date: 59 9 � M SAMPLE TYPE: Mono say year. ;(Routine ❑ Treated Water Time: A w»> Repeat Sample LoeatLocation:PM Untreated Water Collector. (refer to lab, n0. \ P nwN.me ❑ Special Purpose stnaaa. 'Transported /200 �5 �Y+_ �>7 to Lab By: XSame as coliector Other. nme env TO BE COMPLETED BY LABORATORY Sample Receiving: Date: y !7 (3LG i3 Sample ova 30 houra old; Time: Results maybe unrellable RUSH SAMPLE Tem gay ❑ 46 Hour w Phone #: Delivery Method:.. c_ -F Ranota uona —'-�— Fax P. Received By: S -- Comments: Meld For Confirmation .......................Y..................................................................................... _ Bacteriological WaterAnalvsis Record• •r '.. MMO-MUG , (PIA) RESULTS: � re �C: Analysis Began: 1761IZ. Total Coliform:: AND FSK JUN Analyst: `t6 DaWrlme: E. Coll: Analytical Method: SMtto CNrnC MEMBRANE FILTER RESULTS; Phoned - Faxed . Direct C llon: Cdonies/100mL Dele/ritne: Membrane Filter vedricadon: MMO-MUG (P/A) Spoke with: twieoa.nn J LTB: Bca: 'rse Satisfactory Unsatisfactory Reported B Y: Il _L Date/Time: —/�/ P DrL� T"rTc•Too Nam.rouP to count SipnaWre /� -��——r—.�,.��• /l '�j(% 08 .ONvrBn4d. \\Petra\Public\DOCUMENT\FORMSUcro\Coli Form 121703.xis Form # FW- 0053 12/17/03' aro e AWWC V ` � SGS/GT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTNG SAMPLE MUST BE gOMPLETED 13Y WATER SUPPLIER ------ ❑ PUBLIC WATER SYSTEM Me WRNATE WATER SYSTEM Sand Raaulb Send Invoke W.Wsy.amn,ri 7r h hPPr,h Po�.nrro.r •• a.earnr M.rq Asa.r cityZip SenthAOEC. cow MMO-MUG IPIA) RESULT$: ANC FSK JUN SAMPLE COLLECTION: Pa..rmub,...Yd.aw..O..rw b.r.a..iwara. Dah ®Z� 2 0(JL r°ur M riv , Time: , �Q AM Collector. SAMPLE TYPE :5615301 _ S ?/ 2 200W. POTTER DRIVE ANCHORAGE, ALASKA 99518 TeL 907- .%2-2343 Fax: 907-5815301 _, Leb�Rel Ne. 1045410`, ❑Send beele.' ARoudne ❑ Treated Water Repeat Sample ntreated Water Rk ESr4TE5' (refertoleb.no. t . ❑ Special Purpose 'Transported . to Lab By: (Same as collector Other. .m. goon 0 BE COMPLETED BY LABORATORY Sample Receiving: nI� Dater 0sampleover31lhoumeld: ❑ RUSH SAMPLE Time: /. Reaults may be unrewble / .. Tem i Or.✓ ❑ all Nourw"r Phone#: Delivery Method: L F r Ramon L Fax Received By: ��— ! n �g9 Commenla: ...........................................er.........................................................:......... . .................... Bacteriological Water Analysis Record •• SenthAOEC. / MMO-MUG IPIA) RESULT$: ANC FSK JUN Analyals Bogen: 9i (.'Z_�'T �C�2,� TotalCdlform; Datarrlme Analyst 'ly(� E. Colt Sam to Creat Analytical Method: MEMBRANE FILTER RESULTS: Phoned Q Fatted[] ®Dbect Membrane CounC 9' p r . Cdonks/108mL . DatrJTynr Filter veriflcatlon: ❑ MMO-MUG (P/A) �r r Spoke wxh: LTB: BGS: 99 Satisfactory r.wc,wm { EQ- ❑ Unsatisfactory Report ad By-_ .ick/S i Date/Time: aS i(nfiK� Yxrc•tae rwa.rauroea,aa 3iBnanaa an.oewsaarr . 'PI AUG -16-2094 02:14 FROM: TO:3383246 SHORE DRIVE m p N. 69 40' W. 150.00 1� N. 69 40' W. 150.00 TFE 1NFORMATION FEREOV IS FOR TFE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHON EASEFENTS OF RECORD. OTFER F RECORD R OTP ANY COWLICTS SETYEEN EXISTING STRICTlRES THAN TFTS THANT AND PLATTED LOT LINES OR EASEHENT5 AND !S L -D PLA- ARE NOT ED PLA NOT TO BE USED FOR POSITIONING ADDITIONAL RRECOR STTS.C7URE5 OR FEnCELMEO FB 63-I1 ;. E"I'VE D MAY 3 It P.2 Pa 40' AS - BUILT SURVEY NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT 1 HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY LOT 4. BLOCK S. SKYWAY PARK ESTATES ANCHORAGE RECOROING DISTRICT ALASKA AND THAT THE IMPROVEMENTS SITUATED 71-EREON ARE WITHIN TFC PROPERTY LINES AAD NO ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE. ALASKA THIS 3R2 DAY OF MAY96 ----------------- I9------ HOLT LAND SURVEYING TEL. 345-5513 .108 6183 APPLIC 'NT FILLS OUT UPPER HA' ' ONLY P_rop=rty Uwner `) �_": !_„�1;., Phone [I/ Mailing Address Zip Code Buyer jr) r9i l� Date Address Zip Code Lending Institution /-_% f i �, 1� t`-) -� i -v) r (_. /� r)nJfc' Phone iiJ ('rj (--/,_ p- - I /, Address f r �.' i f/ — Zip .. j -. 7 R .Jar//� P Cotle `7 ;,-7 -� Inspector ss� . Realty Co. & Agent Phone Address Zip Code MUNICIPALITY OF ANCHORAGE Legal Description .i /�-7, ayc) r/ /6 2 Street Location /!n Type of Residence GYSingle Family ❑ Multiple Family No. of Bedrooms _ ❑ Other RECEIVED (4�—) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL Water Supply ( ) DISAPPROVED CYtndlvldual ( ) CONDITIONAL APPROVAL- ATTACH WELL LOG. A well log Is required for all walls drilled since June 1975. ❑ Community DATEBY: For wells Urllled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal h i - ❑ Individual t Year Individual Installed,_s�� ” �E Public Utility When Connected to Public Utility: ❑ Holding Tank-`�- NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 1tY� C'-F_itSl S\� Time Time Time Time Date Dale Date Date n Inspector Inspector Inspector Inspector ss� . MUNICIPALITY OF ANCHORAGE Field Notes: ENVIit, I , A . f ,O.P ;i. 1 1:..' 9 IM2 RECEIVED (4�—) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL- DATEBY: Soils Rating —� Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 12023 !31821