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HomeMy WebLinkAboutPARK PLACE LT 3Park Place Lot 3 #020-092-49 f WATER WELL LOG Contractor: Arctic Drilling ICompany PO Box 10-976 Anchorage, AK. 99511 Property Owner: Round -House Builders, Inc. SRA Box 1561=z Anchorage, AK. 99507 Location: Lot 3, Block 1, Palk Place Subdivision Date Drilled: April 13, 19811 Well Depth: 50 ft. size: 6" 'Amount Casing: 41'-2" Static Level: 5' from surface Yield: 15 GPM DRILLING LOG: 0 - 3' Dirt, rocks, boulders; 3' - 17' Clay and gravel Sand ' 17' - 2 . 7 7 y clay i 27' - 31' Sand, Water 31' - 50' Cemented gravel, clay, water Development Services_ Department Building Safety Division On -Site Water « Wastewater Program \/ 4700 Brew Street P.0,.C. Box 195550 Mar`kBegich Anchorane, AK 99519-5650 Mayor www.mum ora/Onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue:`_ Parcel Identification Number: Legal Description Property Owner Name & Address: WPkPk t�FGrr- UD I LLso r CR Pump Installation Date: Pump Intake Depth Below Top of Well Casing: 30 feet Pump Manufacturer's Name: Pump Model: 2:3D 5 p V 3(.-.13 Pnn Pump Size YZ hp Pitless Adapter Burial Depth: / 40 feet Pitless Adapter Manufacturer's Name: kvt� V -CO' Installer: Pitless Adapter Well Disinfected Upon Completion?5? Yes ❑ No Method of Disinfection: Comments: A Anchorage Pune & Well Service Pump Installer Name: 330 East 76th Avenue Anchorage, Alaska 99518 Phone: 907-243-0740 Fax: 907-243-0742 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = _. :-OIL. RATING ":SQ FT.'BR?= 125 THE_ REQUIRED SIZE OF THE _:OIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IhI FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IT THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE Ei;i_AVATION (IN FEET). THERE I= NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF 13RAVEL BETkIEEN THE OUTFALL F'IF`E AND THE BOTTOM OF THE EXCAVATION (IN FEET). I< E-:: ®tia A_a TL r-- IE = C -a ° L E F -° -F 1 (1— -3" F -i P-4 ffi = _=° 1 F= -= I e --a 9_-# 1-. 1 1;3 n I _ L_ Co IIS• -9 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING T"HE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THI`_-'• PROPERTY AND THE NUMBER OF RESIDENCES THAT' THE WELL WILL. SERVE. — •-- — _F 14 fi_Y a-_ 2":e 1 9_8 r -j = r F-: PH' FZ FEE C--! 9_& 1. F --Z S"� -- -_ - _.- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPEC:TION FIND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM Is 100 FEET FOR A PRIVATE hdELL OR 150 TO G_'•.00 FEET FROM A PUBLIC WELL DEPEI•-DING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE. IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 5 FEET. i.JELL UOS, ARE REQUIRED AND MUST BE RE:TURP•dED TO THE DEPARTMENT 14I TH I N _-'0 DAYS OF THE I -JELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT 1.: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND I.JELLS5 AS SETT FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL. THE SYSTEM IN Ai::i_CiF:DANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE 'SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. APPLICANT ROUND HOUSEBUILDERSINC _ ISSUED B --�.___ LHTE2�1�/_ --- r#. 0 DEPARTMENT 0_ HEALTH ''L_, AND ENVIRONMENTAL Fes.-iTECTION _2 -/STREET.- t' l�•,p_:Hr_iF:AGE, FaF::. 99:, l l�s�Ld a _•,a. ' :?�;4-4 ��-�••,y-'!_i /x-81 ®® pp p'^�• nn @@ �g g� ®g•- g per'_ g_ 9 ^ p'- p. -g 6• °-ll L_ IL_ N 9 N -^H B_-`' C:R P-4 -- = • -C- -@ T.- _ °�".1i FE 1_4 B-- N".° �° Fes. C" Z E - 9 _'g'� � 9 •� PERMIT NO. ( �;:.t4�i�=1_9 ; . i APPLICANT ROUND HOUSE BUILDER=, IN SRA BOX 1561 _ 1� w:w;'•� LOCATION LORETTA CIRCLE , ,�J �Y LEGAL LOT 3 Bl PARK PLACE LOT SIZE 43419 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = _. :-OIL. RATING ":SQ FT.'BR?= 125 THE_ REQUIRED SIZE OF THE _:OIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IhI FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IT THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE Ei;i_AVATION (IN FEET). THERE I= NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF 13RAVEL BETkIEEN THE OUTFALL F'IF`E AND THE BOTTOM OF THE EXCAVATION (IN FEET). I< E-:: ®tia A_a TL r-- IE = C -a ° L E F -° -F 1 (1— -3" F -i P-4 ffi = _=° 1 F= -= I e --a 9_-# 1-. 1 1;3 n I _ L_ Co IIS• -9 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING T"HE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THI`_-'• PROPERTY AND THE NUMBER OF RESIDENCES THAT' THE WELL WILL. SERVE. — •-- — _F 14 fi_Y a-_ 2":e 1 9_8 r -j = r F-: PH' FZ FEE C--! 9_& 1. F --Z S"� -- -_ - _.- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPEC:TION FIND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM Is 100 FEET FOR A PRIVATE hdELL OR 150 TO G_'•.00 FEET FROM A PUBLIC WELL DEPEI•-DING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE. IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 5 FEET. i.JELL UOS, ARE REQUIRED AND MUST BE RE:TURP•dED TO THE DEPARTMENT 14I TH I N _-'0 DAYS OF THE I -JELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT 1.: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND I.JELLS5 AS SETT FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL. THE SYSTEM IN Ai::i_CiF:DANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE 'SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. APPLICANT ROUND HOUSEBUILDERSINC _ ISSUED B --�.___ LHTE2�1�/_ --- r#. 0 D, wFla T�-.�y�.i5 � 1 E -2 M { - .c }^�f 5 6 � P a i = } i.'} F � �_ m ". i"t}a--v- }im,Oi'.'ygjT_a F-^ Q,Y --t- 5 iae V}l3 Nr .A: 4 >' 1: Ful QYUL IIF- R W F r ME MW`I f.s3§"res REQUMS) SKIN: 120 As F -7r EN 001 9004 !, F is 2 `1.-rr P -�; : 1 : :'.rv. {{ �3 i E i FR _ � Fyif_i 1 40� 3: 4 F ?r .f _ m€E ?-i �'J ro..SY e �F`f :�5� .ti� �- a' ti j -'t'_', ,. i' IL9 ���_x x�,�k3�� s£ ia�T= �t �3� p y 4'i' / ! i. 3145 t )"C) Y]� C LK��k�F�_k2 ?. T4� 1._Ffg-i•3'�3'- f Af,f`Fjl°_ -ZOW PS TC- LEMS! N F -•-Ar- Qf'F f " R ,a•. k. _ S i"°ri t�i_l i SH ta`:- i 3i 'S M.CRA two m F IS ATE F 1 E �' %Ia p LOT ? a �E 43403 4 34 03 `i CTITY Kim' ". i"t}a--v- }im,Oi'.'ygjT_a - J 301L is'flF IMa < ,i .ep s °' >' 1: Ful QYUL IIF- R W F r ME MW`I f.s3§"res REQUMS) SKIN: 120 As i y sn _ i NIIS T�t_ i i�..5� - ::- 3 v w$ 5 2- . 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U>`M MIS C -URGE 0 asfPz CRS '! r f up 3 (_" AM, a 4 i 3 e4 ; � tr-u 171-0 74 -_ :2 _-g i F - a "3 �? t'-�� $ �� bg z 'z ` r-4 e"�` �,i *�`-`' c t i � s f`5 �_t 0 - S s_ SWUt=sMI (ast, i.I_"E EfEr4EIFAN A k.:IKU, SYS ITATY 301W>£rE c � � _ - er N ,a F >_._ FROM )i f_ �_..- C-,F—F a te s` f G z.rf?7 FEET � � 34`i �� i � s�i� � 3`�;� �����. �� ip,�u, -°�.4'_`3i� � ii :.?i12a at`�: � � € i. t'af 't. .' 4 { rsr�.. r #�i 4 $ S 0 i F@ FIL Fli yam; y F' �- 'fS?TI[=Wml 31 } '-l- t 3 O A P%I �tA TE WE�= I&W s3 IS Min' -f4t` -fct a Clt.,$ I rns r FY .,ten.,.` --f* 1110 Py S 24 0 � =1}�.� s :fi.�_ z`: tX l uP rr i�i*14�x PAW : THE a 2 ?�s 3 ,j ` t "1 < � r r r r_ S �� s.. t '6 $'�''v 'S, f a ! OEM- WMA-61110MR. 4' f. .t,i SiF'. -.1x ...i 't om t:'Fa ``:4 f'uix - �iY>` 'y`' S f-fN y g1'•�?a -kC �S CELS r t`F '1= NMER i � 31 Y ; �'x' =tom s � �-s.. f � a �.��5 � . r 107"F:5704 I 5 F:c b� >' 1: Ful QYUL IIF- R W F r ME MW`I f.s3§"res .:.1.>..a5 i�x sEr G -S 1 i'skg" !"!t>�> 'is_. r��' �'S} ��F'r � O -, its r t € f Pi C! r i rk- i i lx -- '`rf i y sn _ i NIIS T�t_ i i�..5� - ::- 3 v w$ 5 2- . T�is�i 4.,* f�� 14 c M F`iw- is 2 `1.-rr P -�; : 1 : :'.rv. {{ �3 i E i FR _ � Fyif_i 1 40� 3: 4 F ?r .f _ m€E ?-i �'J ro..SY e �F`f :�5� .ti� �- a' ti j -'t'_', ,. i' IL9 ���_x x�,�k3�� s£ ia�T= �t �3� p y 4'i' / ! i. 3145 t )"C) Y]� C LK��k�F�_k2 ?. A fl r,§PGG2 --n -1 ' _ t .-'�z-s,•E',�-aT w, -z'' TIT Al - I 64!L i Depth in Fret Z'rom 'I'o 0.0 0.5 0.5 3.0 3.0 16.0 Soil Descr_iption _' Brown Peat, Pt, damp, soft. F-4, brown Sandy Silt, ML, with trace gravel, damp, stiff, NP. F-1, brown Silty Sandv Gravel., Gini, dame, medium density, poorly graded, occas.i.onal. cobbles, sub -- rounded particles to G". Bottom of Test Hole: 16.0 ft. Frost I.iine: 1.0 ft. Free Water Level: None observed while drilling; None observed 1-12--78 Type of Dry Sample Depth Mo Sample Strength Group Uni-fied 1 5.0 7.2 G N A GA1 2 10.0 8.0 G N A GSI 3 15.0 8.1 G to A GM Remarks: 1. Type of Sample, G=Grab, SP = Standard Penetration, U = Undisturbed. 2.. Dry Strength, N=None, L=Low, ISI=Medium, H=High. 3. Group refers to similar material., this study only. 4. General Information, see Sheet 1. 5. Frost and Textural Classification, see Sheet 2. 6. Unified Classification, see Sheet 3. i January 30, 1978 Page 2 water depths may reflect snowme,lt or surface water. Soil logs on file with the Municipality of Anchorage, Department of Environmental Conservation, for the adjacent property do not reflect the high ground water"shown for this project. Most of the test holes contain perforated PVC pipe and water depths -can be monitored in the future if the need arises. The idealized soil profiles (Figures 2-3) are not drawn to scale, and the depth of the test holes is greatly exaggerated. Soil conditions between holes are interpolated, based on similar soils observed in_the.various test holes. Two percolation tests were performed. The method recommended by the Municipality of Anchorage was used for the tests. Results are as follows. Test Hole T1 Rate 5 min/inch 3.6 min in Required Sq.Ft./ Bedroom 125 C C)t Pa,& P1aze We trust the foregoing is sufficient to your present needs. If you have any questions or if we can be of further service, please do not hesitate to contact us. ROVED: Melvin R. Nichols, PE Laboratory Manager RMH:mfm Attachments Very truly yours, ALASKA TESTLAB "R. Mark Hanse ' ®r-'Aql�qs°Qi Melvin R. Nichols No. 4113•E Municipality of Anchorage • Development Services Department Building Safety Division ;. On -Site Water and Wastewater Program • .I.. 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D._020-092-49 COSA# 1) henWq Expiration Date: I O "2_0 - D C 1. GENERAL INFORMATION Complete legal description PARK PI APF OT 1 Location (site address) 1 64S 1 ST- JAMES CIRCLE, ANrHORArF AK cic) S 1 F; Current Property owner(s) STFVF SPF71At I Y Day phone 145-6223 Mailing address 16451 ST- JAMES CIRCLF ANCHORArF AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Welli ® Individual On-site Individual Water Storage ❑ Individual Holding Tank Community Class Well ❑ Community On-site Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 verity 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. . 111 *I- E- • . •• O Engineer's Printed Name KENNETH M. DUFRIS Date 7/17/2006 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a OF��I system will function satisfactory for current or future �,�Q'��.••••••A;� Os. occupants or can KND guarantee that no unseen C. •.• •,'f encroachments, deficiencies or discrepancies exist. i * AAC • •ti i�/. S. DSD SIGNATURE Approved for 4_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checidist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: 0,A" � Original Certificate Date: -7 —;L 0 — 06 (R. iL05) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: PARK PLACE LOT 3 Parcel ID: 020-092-49 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # _ Date completed 4113/1981 Sanitary seal (YIN) Y Total depth 50 t. Cased to 41_f1. FROM WELL LOG Date of test 4/13/81 Static water level 5 ft. Well production 1 5 g.p.m. WATER SAMPLE RESULTS: - Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 25 n. AT INSPECTION 7/6/06 5.2 fL 6.6 g.p.m. Coliform __colonies/100mL Nitrate 1.97 mglL Other bacteria _0 colonies/100 mL Arsenic: .M mgA Date of sample: 7/6/06 Collected by: KND Engineering Inc B. SEPTICIHOLDING TANK DATA -PUBLIC SEWER Tank Type/Material Date Installed Tank size gal. Number of Compartments Cleanouts (YIN) _Foundation cleanout (YIN) _Depression over tank (YIN) _ High water alarm (YIN) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed moil rating (g.p.d./ftp or fe/bdrm) System type Length ' ft. Width __Jt Gravel below pipe _(t. 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. Elapsed Time:_min. Final fluid depth In Water added_ gal. New depth in. Absorption rate >=, Any rejuvenation treatment (past 12 mo.) (YIN & 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 n. High water alarm level at_in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NA Absorption field on lot NA Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 10 0'+ On adjacent lots 10 0'+ Public sewer manhole/cleanout 10 0'+ Holding tank 100'+ Manure/animal excrete storage areas 10 0'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line Absorption field Water Wells on adjacent lots Water service line Surface SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS Existing septic system abandoned per code and residence connected to public sewer on 6/24/2000. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and AW y '• 9' review of Municipal records that the above systems are in j 9 • k conformance with MOA COSA guidelines in effect on this ;�• •- •" date. rpl . -A id ,A A. Duffu. Engineers Printed Name Kenneth M. Duffus �j CIE 71T Date COSA Fee $430.00 Waiver Fee $ _ Date of Payment ?� /? — 6 G Date of Payment Receipt Number q3 z G jo Receipt Number, (Rev. 11/05) C/ wqi SCS Ret# 1063652001 Client Name KND Engineering Project Name/p Park Place B 1 L3 Client Sample ID Park Place BI L3 Matti: Drinking Water All Dates rimes are Alaska Standard Time Printed Date/Time 07/13/2006 8:21 Collected Date/Time 07/06/2006 13:00 Received Date/time 07/06/2006 13:25 Technical Director Stephen C. Ede Samplc Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic Waters Department Nitrate -N Mierobioloav Iaboratory Total Coliform L9Ly 1.97 0 5.00 ug/L EP200.8 0.100 mg/L EPA 353.2 C (<10) 07/07/06 07/08/06 MI B (<10) col/100m]. SM209222B A (<I) 07/06/06 ALR 07/06/06 TLF W Ordered By. Steve Spezialy Legend: Man Note ® :Lot 0 %Park -------------------' Wet"' W"' iiii3Fence—X—%—L W hl Pole EXCLUSION NOTES It Is the owners' responsibility to determine the OD the of any easemsnts, or restrictions which not ear ions which de o. ILMon should l NOTE. es ehauld any the recorded eubennenn plat NOTE: Under no my r . data hereon be used for construction or for establishing property lines. Z O O O LOT 2 EXISTING BUILDING 4O LORETTA PLACE 164th AVENUE N89'58'45"E 254.36' 10' TELEPHONE do ELECTRIC EASEMENT --------------------------------- LOT 3 CA 0 A LOT 4 NOTE: THIS DRAWING IS NOT TO BE MODIFIED FOR USE AS A PLOT PLAN. Legal Description: AS—BUILT Ordered By. Steve Spezialy Legend: Man Note ® :Lot 3, %Park Place Subdivision Wet"' W"' iiii3Fence—X—%—L W hl Pole EXCLUSION NOTES It Is the owners' responsibility to determine the MzW1tM=on the of any easemsnts, or restrictions which not ear ions which de o. ILMon should l NOTE. es ehauld any the recorded eubennenn plat NOTE: Under no my r . data hereon be used for construction or for establishing property lines. LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS SURVEY CERTIFICATION: LANTECH has conducted a physical survey of this 440 West Benson Boulevard, Suite 200 Phone: 526-5291 property as shown on this drawing and that the Irnprovementa situated thereon we within the property lines and no encroachments exist other Anchorage, Alaska 99503 Fax: 561-6626 than noted. plat: 78-73 Grid: 3337 Date: JUNE 14, 2006 Dram By. TM Work Order. 2006—L-104 Fb/Pg-. 661/58 scow 1* -40' lChodod By. APH MUNIC ' DEPARTMENT( Division c P.O. Box 196650 ALITY OF ANCHORAGE HEALTH & HUMAN SERVICESEnvironmental A Services e Services Section knchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR SINGLE FAMILY !� ZDWELLINGS� AJ � 7-v Parcel I.D. # Z O. 0_ `,Z5` HAA # AJ -z?— %q 1. GENERAL INFORMATION Complete legal description L 3 Location (site address or directions) Property owner LJ�' `��J, �t&tL 5p, Day phone ����� �Z 3 Mailing address Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will.be held for pickup. 2. NUMBER OF BEDROOMS: 31 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site i Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 421 5. 2 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 ofthisinspection. / Name of Firm s1� �� ���"� C - Phone Jc_ L s7 By: Address Engineer's signature DHHS SIGNATURE X. Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date Z, / )LZ,7 of '^egl� y • �F141�� •� :49fit UZ izemore LZ w. 1517E �TF9F •9 • • o... a•unl�th�ed+ �pRO; ESW bedrooms, with the following stipulations: Date 12 -Y—y2- The Y—yZ The Municipality 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 orderto 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. 72-025 (Rev. 1/91) BaCk MOA #21 Legal Description: Municipality of Anchorage Department ofi Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcell.D. A. WELL DATA Well type If A, B, or C, attach DEC letter. ADEC water system number pp Log present (Y/N) / Date completed �YrG� [� ) �j C tB Driller Arcl _ IDLIpIy C� Total depth Cased to I -Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) I � WATER SAMPLE RESULTS: r r Coliform Nitrate �Other bacteria Date of sample: ?7 A10 u_ ,��=I Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size VU Compartments r x � Cleanouts (Y/N) Foundation cleanout (Y/N) _ Depression (Y/N) _1L� High water alarm (Y/N)J Alarm tested (Y//N—)) Date of pumping / � � Zd 0 %? i Pumper SEPARATION DISTANCES DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot PD 6' On adjacent lots / - Foundation � f To property line Absorption fie`d Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front i CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION Date of test J Static water level J3 `< 77 - r7 Well flow Well g.p.m. g. n' Pump level L SEPARATION DISTANCES FROM WELL TO: / � /�T y Septic/holding tank on lot -;On, adjacent lots > ! C m Absorption field on lot j ; On adjacent lots �' 10e?( j Public sewer main Public sewer manhole/cleanout GV Sewer service line 4-eo / I i Petroleum tank WATER SAMPLE RESULTS: r r Coliform Nitrate �Other bacteria Date of sample: ?7 A10 u_ ,��=I Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size VU Compartments r x � Cleanouts (Y/N) Foundation cleanout (Y/N) _ Depression (Y/N) _1L� High water alarm (Y/N)J Alarm tested (Y//N—)) Date of pumping / � � Zd 0 %? i Pumper SEPARATION DISTANCES DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot PD 6' On adjacent lots / - Foundation � f To property line Absorption fie`d Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front i CONTINUED ON BACK PAGE G. LIFT STATION Date installed t --I O ` Manufacturer Size in gallons6Z5 Manhole/Access ( ��` �/ tl Vent (Y/N) i "Pump on" level at "Pump off' level at High water alarm level 4W A Cycles tested Meets MOA electrical codes (Y/N) Y SEPARATION DISTANCE FROM LIFT STATION TO: p � Well on lot ` 6,) R On adjacent lots D. ABSORPTION FIELD DATA Date installed 1 q �, Soil rating ' Surface water System type CVS a UP,� ! Length 60Width 1-2-- Gravel thickness Total depth Total absorption area 7 Z<D Cleanouts present (Y/N) Depression over field (Y/N) �11 Date of adequacy test Results (pass/fail) a�5 for Z� bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ' l Z>On adjacent lots ���( Property line r r A)o e_ To building foundation � `�-� To existing or abandoned system on lot � - Onadjacent lots �> Cutbank None- Water main/service line a /K-) Surface water N virlF' Driveway, parking/vehicle storage area ) < cl Curtain drain 1\3 0o e� E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. z.; Signature o V 61_ -- Engineer's Name �Ll ' ) i/ r�! ®.o$ ,ea 0 o u°o sne / /V 0V, 7 -Z ®gym u James F. Sizemore [ S. Date a 44 t, e o �� HAA Fee $ /70,07) Waiver Fee: $ Date of Payment G Date of Payment Receipt Number Z�� 7 - Receipt Number 72-026 (Rev. 3/91) Back MOA 21 NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 • FAX 274-9645 I Sizemore & Associates I Report Date: 11/18/92 6410 Switzerland Drive Anchorage AK 99516 Date Arrived: 11/13/92 Date Sampled: 11/13/92 Time Sampled: 1010 Attn: James Sizemore Collected By: JS Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: Lab Number Method -------------------- A121440 EPA 353.3 A121440 Park Place L3, Blk 1 Water Parameter ----------------------------- Nitrate -N Reported By: Susan C. fental Microbiology Supervisor Units mg/l * Definitions * B = Below Regulatory Min. H = Above Regulatory Max. E = Estimated Value M = Matrix Interference D = Lost to Dilution MDL = Method Detection Limit Result * MDL -------------- 0.4 0.1 Date Date Prepared Analyzed ----------------- 11/17/92 m MUNICIPALITY OF ANCHORAGE DEPARTMEN4i -SF HEALTH AND ENVIRONMENTAL PRO'rsCTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 �7 Application Date z. G 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) ZZM)PW Siy Location (address or directions) (b) Applicant Name Mr-Jrji,& 54-�"�Te'ephone: Home �✓/`t c 2z✓Business -56tlzz— ,z Applicant Address z ft-�2 L 27-- p (c) Applicant is (check one): Lending Institution El; Owner/builder ❑ ; Buyer ❑ ; Other)q (explain); 60— Iwe (d) Lending Institutionfa���d—e7d%"—e��e� I viePphone Address �l�(Z2 % 9 ! �25��/ (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: _ 2. TYPE OF RESIDENCE Single -Family f, Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Weir Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite;EL Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING;PECTIONS, TESTS, FILE SEARCH, DATi,__,JD INFORMA i wry ion of As certified by my seal affixed hereto and as of the validaion dwas shown below,dispoI v systemify that s safe, f st 9 otnal and this Health to Authority Approval shows that the on-site water supply and/or 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. , 2 f 5 1 R r/i') S SD ZC�'%% y�lephone 7 /� Name of Firm _ _ _ _ �k-2 L :ff�/ Address ^� Date 2 (f 6. DHEP APPROV Approved for ;�� bedrooms by atjr Approved Disapprov Conditional Terms of Conditional Approval Chep CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA)1--) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: L3 -e /115�'jd C e A. WELL DATA Well Classification ra lC j If A, B, C, D.E.C. A proved (Y/N) j' Well Log Present (Y/NJ) Date Completed Yield ./_J5 Total Depth� Cased to % Depth of Grouting Static Water Level jbw to/ Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) f Electrical Wiring in Conduit (Y/N) r Depression Around Wellhead (Y/N)1 Separation Distances from Well: J To Septic/Holding Tank on Lot /'b� �� ; On Adjoining Lots�* � %R i To Nearest Edge of Absorption Field on Lpt ; On Adjoining Lots 9 L To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA To Nearest Public Sewer To Nearest Sewer Service Line on Lot / � Or -e ; Date Date Installed Size %000 6_FNo. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) `/u Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/ Holding Tank* // To Water -Supply Well t 62 C� / To Building Foundation !(Q J // � To Property Line — yQ To Disposal Field l.�G% To Water Main/Service Line / 1 To Stream, Pond, Lake, or Major Drainage Course Comments h"L"4tCIPALITy OF ANCffORAOF Page 1 of 2 EIVVfRO PT. OF HEALTH & NMEN & PROTECF10N JN 28 72-026(11/84) ECEI M) C. ABSORPTION FIELD DATA �( D u k2 _/ �� y5 Soils Rating in Absorption Strata . Type of System Des' ; Date Installed / Length of Field Width of Field, r Depth of Field g, 2 �r Gravel Bed Thickness Square Feet of Absorption Area { ` Standpipes Present (Y/N) / Depression over Field (Y/N) `vDrate of L st Adequacy Test Results of Last Adequacy Test 5, S4J a s :�V P 7n O Separation Distance from Absorption Field: To Water -Supply Well (� To Property Line To Building Foundatiors To Existing�or Abandoned System on �l Lot �A)ne _ On Adjoining Lots l55 To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course . 4,/ 8/_�s A, To Driveway, Parking Area, or Vehicle Storage Area % Comments D. LIFT STATION Date Installed / L yJ Dimensions Size in Gallons d© (f_a Y Manhole/Access (Y/N) "Pump On" Level at `L"TZ71"Pump Off' Level at High Water Alarm Level at 50 Vent (Y/N) r Tested for ©/1 (f - Pumping Cycles during Adequacy Test. Meets MOA ivn,n LX ** Check Permitted Bedroom Rating Against HAA Request ** I certify thaM have checked, verified, or conformed tto II MOA and HAQA guidelines in effect on the date of this inspection. Signed Date 7��v- l0 V ComMOA o. �a Y Receipt No. 6� Inv 44�i�� e Date of Payment 67a °pe°pEUDE b*D° eV� ®° ftp is°�el Amount: $ f�® 0�00aa 0000 eyg°°e%�i(y abtl�oN bo 0 in o James F. S&rnora Page 2 of 2 15171- a�4��HROFF 551�� 72-026 (1 1184) •vN/C/P�l Dept O.P IRONFP4 ��TN�ORAGF 2 pR0T�` 01V "JIFcFlVJ.a A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA)` HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: --- Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield 7 Total Depth J ( Cased to ' ! / ,Depth of Grouting Static Water Leve :` Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) A Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: , � } Z: <f l To Septic/Holding Tank on Lot 'W r)) � � On Adjoining Lots X<< i i To Nearest Edge of Absorption Field onLot _ ; On Adjoining Lots Cl To Nearest Public Sewer Line "\/L _ To Nearest Public Sewer Cleanout/Manhole h To Nearest Sewer Service Line on Lot Water Sample Collected by.�'� / %',�?�` ; Date Water Sample Test Results <(� Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) j . Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) \ - Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Nodding Tank: To Water -Supply Well To Building Foundation Z63 To Property Line To Disposal Field To Water Main/Service Line ! `� To Stream, Pond, Lake, or Major Drainage f " Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA r Soils Rating in Absorption Strata Type of System Design Date Installed �Length of Field' - Width of Field Depth of Field / Gravel Bed Thickness / Square Feet of Absorption Area // ( 0 Standpipes Present (Y/N) Depression over Field (Y/N) /YI wl !L! Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: / To Water -Supply Well ' To Property Line / To Building Foundation % -�% To Existing or Abandoned System on Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION i Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments —'' On Adjoining Lots' To Cutbank (if present) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed `u Date ), r Company --)MOA MOA No. � Receipt No. v )F7 n i'4 /-L Date of Payment v� Amount: $ 49 Page 2 of 2 72-026 (11/84) e'..,;O •YQ�i• ,C�Jf_ ..t RC1 ) / GJ 7`l 14, L- FLO ; UD L,, l lr✓`� I � 57-A 5. LEGAL DESCRIPTION �. ,SLI'. % &--1 &� DA -,f RECEIVED INSPECTION APPOINTMENTS TI MA_ TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR ( �" MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCI-IORAGE ?-._L? DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOMPT. Of -i 825 L Street - Anchorage, Alaska 99501 ENVIRONMENT+. -. ,.. j ECTION • ENVIRONMENTAL SANITATION DIVISION (-l- -, (, 7 (31 .; Telephone 264-4720--�yy ❑ COMMUNITY REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S MEI DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER „ 8. SEWAGE DISPOSAL SYSTEM PHONE k 71 MAILING ADDRESS " ANCH. AKI YEAR ON-SITE SYSTEM WAS INSTALLED. PRO�P�E{�R/��T//Y,, R/ESIID//ssENT (ifddifffeJr//pnt from above) PHONE 5 U l vhf' -V` ( — -11 1� 2. BUYER i?� % ! Ghe PHONE MAILINIG ADDRESS , 3. LENDING INS ITUTIO c u'56 PHONE MAI /LING ADDRESS _ 4. REALTOR/AGENT ` &1'1?36'GJ /� 61 PHONE S,e336�r�� 9y�� 5. LEGAL DESCRIPTION �. ,SLI'. % &--1 &� S/TR�EET LO ATIO/N /. 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATELY R 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.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE**� YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 ( Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX s 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 APPROVED FOR _ ��BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE�/ OZ� 0/ BY (/�?� / — f 1 r Ali /. r 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GLORGE M. SULLIVAN, MAYOR 7a'sn 9-1q-9) �bill gs- DEPARItvdENlOFHEAI-IHANDENVII;ONMENIiVI_ PROIECTION l\ n' V 1 September 14, 1981 Round -House Builders Star Route A Box 1561Z Anchorage, Alaska 99507 Subject: Lot 3 Block 1 Park Place Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water facilities were not turned on at the time of L-_�)/C'the scheduled inspection. Please call this office for another inspection. (2) At the time of the inspection, the well was not located. Please expose and mark the well for our inspection and to insure distance requirements are met. (3) A permit has been issued for the well and on-site sewer system. We have not received the as-builts of the installation in this office. If a private engineer inspected the system, please send us the report for our files and review. Please notify this office for a reinspection when the noted descrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, James.S. Roberts Associate Environmental Specialist JSR/ljw cc: Alaska Mutual Savings Bank 1503 West 31 Avenue 99503 Municipality of Anchorage MEMORANDUM DATE: September 23, 1981 TO: Laura Crow FROM: Senior Office Assistant Sewer and water Program SUBJECT: Request for Refund - Account #2460 Please make arrangements for a refund for the following. A private engineer inspected this system as it turned into a special design. Round -House Builders, Inc. Permit #810089 Star Route A Box 1561Z Anchorage, Alaska 99507 Check #2953 Receipt # 133832 (written at the Building Department) Amount: $30.00 cJ1 ' Laura J. ward Senior Office Assistant attachments