HomeMy WebLinkAboutHIGH HOME BLK 2 LT 2AHigh Homes
Block 2
Lot 2A
#050 - 321 - 75
Aug 03 22 10:16p Anchorage Well & Pump Ser
9072430742 p.1
MUNICIPALITY OF ANCHORAGE
��,� -tell
Development Services Department J Phone: 907-343-7904
On -Site Water & Wastewater Section
Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number:
Parcel Identification Number: 050 321 75
Date of Issue: - -
Legal Description Block Lot Property Owner Name &Address:
SCHNELL ROBERT & KRISTA
HIGH HOME 2 2A 18734 UPPER SKYLINE DRIVE
EAGLE RIVER, AK 99577
I Pump Installation Date: 07 - 2e - 2022
Pump Intake Depth Below Top of Well Casing:
Pump Manufacturer's Name: MYERS
Pam uModel: 3NFL, 8GPM
Pump Size: 1.00 hp
Pitless Adapter Burial Depth: 10
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
410
feet
MENARD
Well Disinfected Upon Completion? )<Yes ❑ No
Method of Disinfection: PELLETS
Comments:
feet
Pump Installer Name: _
ANCHORAGE WELL & PUMP SERVICE
Company: 7640 KING STREET
ANCHORAGE, AK 99518
Mailing Address: _ 907-243-0740
City: State: Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
yr w
• Municipality of Anchorage Page k of 2—
• ,
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: °i1 006:13 PI D Number C 'o"2'L1S8
Name; itber�4c>r
Wastewater System: XNew ❑ Upgrade
Address:
ABSORPTION FIELD
Phone:
Upc1 4- - ( 4cl e" t
No. of Bedrooms:
'3
0 Deep Trench $hallow Trench 0 Bed 0 Mound 0 Other
LEGAL DESCRIPTION
Soil Rating:
Or d GPD/Sq. Ft.
Total Depth from original grade: j
4
Lot: ` �BBlloocck: ��
tM� 2. & /`�If+' 2
Subdivisi /
�1 G
Depth to pipe bottom from original grades
Z Ft.
Gravel depth beneath pipe 1
? . Ft.
Township:
Range:
Section:
Fill added above original grade: i
2.5 — 4.5 Ft.
Gravel length: q 1
r Ft.
WELL: New ❑Upgrade
Gravel depth', S• t
4.-t 1 u -i1 Ft.
Number lines:
Distant et leen lines:
Iv A- Ft.
Classification (Private, A,B,C):
Total Depth:
Ft.
Cased To:
Ft.
Total absorption area/: J �� /
-x"I SQ. Ft.
Pipe material: JO t,.�"'t/t;
ken -1 930a>+ f.
Driller:
Date Drilled:
Static Water Level:
Ft.
Ter: p in f
l ,�J�� -G
Date installed:
—11 .-q I
Yield:
GPM
Pump Set at:
Ft.
Casing Height Above Ground:
Ft.
TANK
SEPARATION DISTANCES
$Septic 0 Holding ❑ S.T.E.P.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
Public/Private
Sewer Lines
M Uf Ctur¢l:
C./P-, i k-
Capacity in gallons:
1 coo
Well
1
1 XGO
Material:
Number of Compartments:
Water
1004
fin
,.
✓
LIFT STATION
Lot
Line
1;,
10
I k
!
14
/
/Size
in gallo .
�i anufacturer:
Foundation
1e
/
"Pumpon" level t:
"Pum off' level a :
p
i f h water alarm at:
Curtain
Drain
Q 1 J
L
b
Pump Make & Model
Electrical Inspections performed by:
Remarks:
BENCH MARK
by -1 sav -co A
Location and Description: `
TO` or �z..)t-S'i7r�, 0 N
9 ate- c foci -ry A -r e vi .:s
\r -S fr .-<< t3 < 01,-1 A
�/ ^ `
Assumed Elevation: p
}-- J 1
1 ~- Ft
ENGINEER'S SEALy
OF f
Ca b'�
a CS CNeINCCRINC
17034 Eagle River Loop Road 140! 204
Inspections performed �gle River, Alaska 99377
Dates. 1st 5 -k b-91
A'y`��
"••:•'4 -
er 6) y ~ea -'y.j
6 P ‘'.aa *r.`
2nd S-t7-°tl
��
Department of Health and Human Services approval
Reviewed and approved by Date. d9 9/
y/LA-J-0Ln- az. /6 A
o'. 4.�Shafer ke,
+��,
te;=
72-013 (1/91) MOA 25
1 Permit No (1 1 e::::o`tt
•
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: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Lot 2 rL4.. 2- Or% 14 a
NI
!A
PID No.: 05-o'321 SS
G.( Goa c- ' Ht
31%
•
3
`TH "/ -r
""/
6�N:t9C, (x4s1-1ri��
2
15
til
A,s
115M E, t7 v-- h- eis/tono-1 s OFea Z
I.I.IrJG Cr t 'i—I=,-1
t'(= 5 Ni{ICA1.
72-013 A (2/91) MOA 25
•
� ntfir? Otithn Cog
by
OOC Co. dba
OWNER OF LAND
SULLIVAN WATER WELLS
P.O BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
Q1CA14,c 2 , 4.73enl
ADDRESS Ila 3/ /?4'oQf4 elAtcs 1£
LEGAL DESCRIPTION L a Qttn4 t1IcN NanvEer
DATE - Started
PERMIT NUMBER
Ended
DEPTH OF WELL /2c
STATIC LEVEL OF WATER FT aI
DRAW DOWN FT
GALS. PER HR
KIND OF CASING
a3
fo(J
KIND OF FORMATION.
From 0
From Q
From
Frommel
From PD
FromflC
From_
From ! ! 7
From / 3
Ft. to Ot Ft. C4ren1 C STICI;t1 p From 3(3 Ft toy Ft
Ft. to_l Ft 0O ABJQDE n) From Ft. to Ft:
Ft. to-.L___Ft. BEd Oa CC Ce€1 From Ft to Ft.
Ftto r0 Ft A EA4RaCC /ec,4C.%4 From Ft to Ft
pp POCK t�EE
FL to 1� 'Ft 6 FOFrom, Ft to - Ft
Ft.,to / I 1 Ft. - A EmaCL C1F&9 - From Ft. to Ft.
Ft. to Ft. 43,4,
u1/ crz £E14.I1,c From Ft. t
i2
Ft to Ft 'Rail OCC Gia» From Ft. to
Ft. to 1.3a Ft. £ 66A OCKE.JI From Ft. to Ft.
Ft.1.J/ t?34cTL C?& iu From Ft to Ft SEP 3 1991
ntcipality ptAnchorage
Ft. ac -12A OC t 6 fe t,tl From Ft to Health & Fltlmaa Cervices
Ft. Qt4k)t c C,PtE.J vl
Ft. 7t? J 44 %L SEnN'I.r
Ft. &6Qgcc 6,6E• '
/3 COQo cc
ethini
Ft.
FRECEIVED
From Ft to
Ft. to (00
From a ba -Ft. too/ Q'
From Ft. to
From 0262 Ft to .3302
From/in
From 30
From
From 3to
From Ft. to Ft
From- Ft. to Ft
From Ft. to - Ft
Ft. to Ft.
Ft. .to _360 - Ft. 13Poi c 6 its/)s/ From
Ft. to Ft. QJ 144.72-
/ From Ft. to Ft.
Ft. to 36? Ft. _Agat e-61E6^� cors oeo QJ/FR%tt. toa3',t'
MISCL. INFORMATION:
rD 1 td
c q& Je
DRILLER'S NAME N. 1,1 (, a YO
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW910093
DESIGN ENGINEER:S & S ENGINEERS
OWNER NAME:MATSON RICHARD W & KRISTINE A
OWNER ADDRESS:18734 UPPER SKYLINE DR
ANCHORAGE, ALASKA 99577
PARCEL ID:05032158
LEGAL DESCRIPTION: HIGH HOME BLK 2 LT 2
LOT SIZE: 39594 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
DATE ISSUED: 5/08/91
EXPIRATION DATE: 5/08/92
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
7, 4 % - ,c),/ 4 7
RECEIVED BY:
ISSUED BY:
at -
et -o
6 1/4/p/
DATE: C^ F- g/
DATE•f -9.-V
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
ROBERTSHAFER, P.E.
ROGER SHAFER
May 6, 1991
MunLcLpaktty o6 Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 2; Block 2; High -Home Subdivision;
PERMIT REQUEST NARRATIVE:
CIVIL ENGINEERS
(907) 6942979
FAX 694-1211
The septic system px°posed got the re6enenced pxopexty consists oS a
1250 gallon septic .tank with two draingietd trenches. The d&ctLn6ietds
cute to thavexae amiss .the slope with a spL t -avec connecting .the
trenches together.
The attenate septic site proposed got the property is a Slat area
considerably towe't in elevation than the original site. The attexnate
bed system will be very shallow below anginal grade, howevex, it is
tow enough in elevation that a tL1 t station wilt not be necessary.
The neighboring property owner ag Lot 7; Btoek 4; Rotting Hilts
Subdivision; would not allow us access to his tot to locate his well,
thete6ore, a measured distance could not be obtained. However, he
ingormed us his well is on the opposite side og .the house as hia septic
system which would place it °vet 100 gt. Sum out proposed systems.
The proposed well radius cats into the adjacent Lot 1; Stock 2;
High -Home Subdivision, however, due to the targe tot sizes, we do not
6eeL the A. ' '"ion og the proposed well and septic wilt adversely
ebUeet .'vetopment og any neighboring pxapetties.
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
BERT A. SHAFER, P.E.
JS/gm
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
= Sb
SCALE
N I A:
w 12So
4s
PITA'
ss •t 4 pl S
¢ - lam Ci?17
lY" l2t5 o
riot
L. -4a = o. S
coot.. 0, e. = -So " r -c ---Q‘17.
et_aS -
Q€
4i'I�
2t 1"_/›vt
*4
14,
ty�
j}cek
Dhygrc324 l
SSE t- 117 519115.4
o4 ftioT tea `c.la—
eotL.* = o.5 G,Po/F"2-
(pOo - o,S
120' t--D\c
Vrosi
MCCg4-zy 1
"Ce;59-i t 1CC1
l k-�S�t smart Ptt -t "-P034lotpS 4 LSS W'r
3,S r-
01 NsCAI 6&co
fis3L m'. ° a 4" a
n14.,�`� bwa.� w
,.. oa',$
•3
sem;• .
0
In
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: I 1 �•1�lJs
LEGAL DESCRIPTION: 4 252. 4.1 _ 0-netcTownship, Range, Section:
SLOPE
DATE PERFORMt#a1
4ober( A. Shafer
No. 1457-E •
0
DEPTH
(AEET)
1
2
4 _ �� 1` Q7 /v14 4r
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
r r
WAS GROUND WAT
ENCOUNTERED?
IF VES, AT WHAT
DEPTH?
ER
n
S
L
O
P
E
Depth to Water MIec,
Monitoring? ! !/7- Dale:
SITE PLAN
t
N
C
1Ea
5- I�
ql
T4
2
Reading
Date
Gross
Time
Net
Time
Depth o
Water
Net
Drop
��
1
4 -9 I
b'_ rv..r.
104(z"
--
�'
toMi�.
its-"
I°
3
t,
7 y ( ,
7/"
4-
0
7 J/'y
I
5
"
i •s/g 11
:177e71/, "
7'/a',.
PERCOLATION RATE i\•4 (mites/inch) PERC HOLE DIAMETER O"
TEST RUN BETWEEN
COMMENTS
PERFORMED BY.17034 Eagle River Loop Road No. 204
Eagle River, Alaska 995�z
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI _. IN - FECT ON THIS DATE. DATE
72-008 (Rev. 4/85)
ND "' FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
DATE PERFORM&
LEGAL DESCRIPTION: L2$2 41414 - 140 -1-16. Township, Range, Section:
DEPTH
(ReeT)
1 —A. " z$-
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
of
O
o7
7
e
r
COMMENTS
r / 54 Laic
D.8 etly
ca
SLOPE
WAS GROUND WAT
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water Atter 1
Monitoring? lc"
ER
0
Date: 64-9
s
L
0
P
E
SITE PLAN
Reading
Date
Gross
Time
Net
Time
Depth
Water
o
Net
Drop
/ �y
�a
}L
I t-1-cl.
2t?-‘
r
9�'r
"
--
2=�7
1''
�� rt
`
q
Y
51%Y
vs
;
/+bb'j
3
1 c
1
n1�r
Y1
',145
, o 'Ir.
,
1
PERCOLATION RATE
_irCiLl
(minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN
FT ND
t
FT
S & $ ENGINEERING
17034 Eagle River Loop Road No. 204
PERFORMEDta1t'gle iaivar Alaska 99577
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI /ECT ON THIS DATE. DATE -
72 -008 (Rev. 4/85)
SEP 07 '90 15:50 RE/MAX OF EAGLE RIVR
;;.;.MUNICIPALITY OFANCHORAGE;.:
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
05 L. Street, Ancherape, Alasln 49501' 2644720 ,.
SOILS LOG - PERCOLATION' TEST
PERFORMED FOR; aL* r'i`' Jr •Gri) .....:... : 4/4/e
DATE PERFORMEb: J' � '� ,
LEGAL DESCRIPTION: el.+t ,e/,fir' a 179A Won, et S4, ,h,
. .SLOPESITE PLAN
P,2
!'SOILS LOG
PERCOLATION
TEST •
OK'G4WIc
rap se
Sa ti dy 6v4 tc.,l CG -P)
/y6
46/ r[w....
10
11
12
13
BGctroc.
14 OFA lift
til• ••• Set,
15 � •. *191t3. t I
16...=•141/06911.•••••... g
a
17 Lew. A. ISM; S/
•'.. CE6736�$'
18
19
y
t5p
ti
1
r
r
WAS GROUND WATER Ci . 5
ENCOUNTERED? L
0
P
E
IF YES, AT WHAT
DEPTH?
•
ICT
•s .
ireaS
T
:
FIGURE 7-23
RELIEF LINE DISTRIBUTION NETWORK
'Flow From Pretreatment Unit
Distribution Pipe r--' A
Absorption
Trenches
Follow Contours
14- Relief
Line
lEnds Capped
.A Distribution Pipe and
Relief Trench to be Level
Line
Distribution Pipe
Relief
Line
1
279
Municipality of Anchorage •
On-Site Water and Wastewater Program
(907) 343-7904
ilL I i"
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-321-75 Expiration Date: )2, /i 746-
1. GENERAL INFORMATION
Complete legal description -High Home Block 2 Lot 2A
Location (site address) 18734 Upper Skyline Drive
Current Property owner(s) Heagy Day phone 726-7153
Mailing address same
Real Estate Agent Owner Day phone 726-7153
2. TYPE OF DWELLING: 6 7 8 g ;;
® Single Family (w/wo ADU)
❑ Duplex t!'';)-•
❑ Multiple Dwellings (Single Family and/or Duplex) a SEP 0 •6
ti
3. NUMBER OF BEDROOMS: 3 c>
68Lc'•A
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Received by: -� i %IAA. G / Date: j /�, 7�
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5216, Date:
Date of Payment 914l18 Date of Payment
Receipt Number r ?6`7' Receipt Number
COSA# t �3(`0 146-9 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 9/4/2018
•
S:
6. DSD SIGNATURE •!c.,-- t l.• ."%1 '•
v System #1 Approved for 3 bedrooms. .,
System #2 Approved for bedrooms. . . • str....c., Eng ,<,4
Disapproved. / •n''t, 0
Conditional approval for bedrooms, with the following stipulati pf„, ,: 'may
oci Oh itivc,o
A
. ON-SITE c
WATER AND z
WASTEWAT o,,,,,,,
„.....„TrpRosGwRik:„. .„."...
By: / / W Vii,,i,. Original Certificate Date: R 7 /g
7
The Municipality of Anchorage evlopment 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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory X Other 7,ik X dv I yor/
COSA blue sheet_9-1-12.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: /!( e q /-70/14 Lc L 2 Z 2A Parcel ID: OSo 32 J 7.5
A. WELL DATA P
Well type If A, B, or C provide PWSID# Well Log (Y/N) y
Date completed 5/?! Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depthq'20ft. Cased to 20.3ft. .ZNTO Casing height(above ground) /Z/ in. -4-
/3
+/3 EC)Rock_
FROM WELL LOG AT INSPECTION
Date of test 5(9/ 7/37/e
Static water level 2 l ft. 75. 2 ft.
Well production Z 3 g.lye.h. 0. ? g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate S. /q
ng/L
Arsenic A.)._6 ug/L Date of sample: G/ 4//e Collected by: /v/p,,k
,_..c 7
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material sFPrIc--/SreEL )6- Date installed —511C/7/
Tank size /DOO gal. Number of Compartments Z Cleanouts (Y/N)
Y. l
Foundation cleanout
(Y/N) V
V
Depression over tank(Y/N) A� High water alarm (Y/N) /
Date of pumping // I Pumper A' 6z)J4 fi -cio A c_
C. ABSORPTION FIELD DATA 8
Date installed 5/1779
/ Soil rating (g.p.d./ft2 or ft2/bdrm) O. System type .1e,a t°""i
Length 7? ft. Width 5 ft. Gravel below pipe Z ft.
Total depth 7 ft. Eff. absorption area 561' ft2 Monitoring tube �/ Depression over field Al
Date of adequacy test �/3/� 8 Results (Pass/Fail) P ( For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added GOO gal. New depth Z in.
Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >= 4/50->F' g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N & type) /v If yes, give date
D. LIFT STATION A.64
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot /9 f On adjacent lots /lc -�-
Absorption field on lot /d Q 1-rOn adjacent lots /D a� ��'
Public sewer main /001-f- Public sewer manhole/cleanout /OQ '4"
Sewer/septic service line Z S "t- Holding tank /tea 4-
Animal containment areas 50 -f' Manure/animal excrete storage areas /00 11-
SEPTIC/HOLDING
fSEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'4- , „
line /2 'f' Absorption field Jc—
Water main 'f' Water service line /0 /4Surface water � QQ '''F'
/�
Wells on adjacent lots /OO
ABSORPTION FIELD ON LOT TO:
Property line /O Building foundation /D -' Water main / O (-I-
, „ i1_,_
Water Service line �0 7 Surface water /QQ 'f' Driveway, parking/vehicle storage
Curtain drain 50 '1 Wells on adjacent lots /OO 11-
F. COMMENTS
?P TAA/k LEVIL Ais()gFo ,roRA//A/C PR'r c,
p Fele o c t)A4-y,-- of
G. ENGINEER'S CERTIFICATION
. r
F
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in n ,1 •.
conformance with MOA COSA guidelines in effect on this date. Y
Engineer's Printed Name S 7”61/6 /V G
Date ?/y//e ,, ,
7 /1 if ' ' . .
COSA yellow sheet_2-6-15.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • FT('-, 907-343-7904
On-Site Water and Wastewater Section \ ` / Fax: 343-7997
www.muni.org/onsite
Well Water Advisory
Certificate of On-Site Systems Approval # 0SC1459
Subdivision: High Home, Block: 2, Lot: 2A
This well's productivity was determined to be .9 gallons per minute. The minimum
well productivity required under (AMC 15.55) for a 3-bedroom residence is .31
gallons per minute or 150 gallons per day per bedroom. Although the subject well
currently exceeds this minimum requirement, the production capacity can
fluctuate and may be insufficient to meet your needs.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.0. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
On-Site Water and Wastewater Section \ � Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory'
Certificate of On-Site Systems Approval # OSC181459
Subdivision: High Home Block:2, Lot: 2A
The septic tank for this property is 27 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
•
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Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org
MUNICIPALITY OF ANCHORAGE •
DEVELOPMENT SERVICES DEPARTMENT I ® 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory'
Certificate of On-Site Systems Approval # 0SC181459
Subdivision: High Home, Block: 2, Lot: 2A
A water sample revealed a nitrate concentration of 5.97 milligrams per liter (mg/L).
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.O. Box 196650* Anchorage,Alaska 99519-6650 *www.muni.org
IN:-----...„.
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ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 688-4566
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE:
FOLLOWING DESCRIBED PROPERTY:
] "=30' ��Of 14°pf
//76. //o/L1E'SU�LoT 2�Bee_Z DATE: a'SS;•........4 fs,4
AN THAT NO ENCROACHMENTS EXIST EXCEPT AS 10-28-91 ,..�A,''.••., .TH j";••••7+-t�
INDICATED. IT IS THE RESPONSIBILITY OF THE ,° * ; $
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: o'"' Y�
EASEMENTS, COVENANTS, OR RESTRICTIONS NW 254 / ::`�' z' �•. p
WHICH DO NOT APPEAR ON THE RECORDED SUBDI— �� ' :• Duane Mark Seward p
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' �'`�,�' '• 15 69.1 l'Q
24-30 `'t• • �i/�l
ANY DATA HEREON BE USED FOR CONSTRUCTION A/,', •'
OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: ' % '�'c'ssl���ai.�"-'S4
ARY LINES. 'kb,�� �
DMS
Municipality of Anchorage
On -Site Water and Wastewater Program
•
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 050-321-75 Expiration Date: 7-/3 -
1. GENERAL INFORMATION
Complete legal description High Home BIk2 Lt2A
Location (site address) 18734 Upper Skyline Dr., Eagle River Ak. 99577
Current Property owner(s) Richard W Matson Trust Day phone
Mailing address 18734 Upper Skyline Dr., Eagle River Ak. 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
0 Duplex
9 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community 9
Public Water System ❑ Public Sewer 0
WaiverNariance request for. Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 14610 a Waiver Fee $
Date of Payment Jf?3/L') / Date of Payment
Receipt Number ovis-g1v1 0O Receipt Number
COSA# MC-I61We 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 Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
Date 130 t b
h Panrlgne '
CE -8149
bedrooms, with the following stipulations:
N.
�llhll(tUw,67i
Z\ `gQy�Y OF,gN04
`N ti° i
ON-SITE i�+
WATER AND
WASTEWATER
PROGRAM co
y� � 1
j4f )s RNA , \;r
By:nicipa /4/' Original Certificate Date: 1 " 02,1 " / 3
The ! - a�:rage Development Services Division (DSD) issues Certificates of OnSlte Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional dvil 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 X
Septic System Advisory
Well Flow Advisory
COSA blue sheet f c
vet ,
Nitrate Advisa-ry-,
Arsenic Advisdr'
Other
3 '1'
•
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: High Home BIk2 Lt2A
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 5/91 Sanitary seal (Y/N) Y
Total depth 420 ft. Cased to 204 ft.
Date of test
Static water level
Well production
FROM WELL LOG
5/91
21
.38
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL
Arsenic ND ug/L
ft.
g.p.m.
Nitrate 1.04 mg/L
Date of sample: 1/7/2013
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N)
Date of pumping Pumper ' -S
Parcel ID: 050-321-75
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 18 in.
AT INSPECTION
8/22/12
74
0.35
ft.
g.p.m.
Collected by: PES
Date installed 5/16/91
Cleanouts (Y/N) Y
High water alarm (Y/N) NA
C. ABSORPTION FIELD DATA
Date installed 5/17/91 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 sf/bd
Length 79 ft. Width 5
System type Trench
ft. Gravel below pipe 2 ft.
Total depth 7 ft. Eff. absorption area 564 ftMonitoring tube Y
Date of adequacy test 8/22/12 Results (Pass/Fail) Pass
Fluid depth in absorption field before test 14 in. Water added 460
Elapsed Time: 80 mina Final fluid depth 14
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
Depression over field N
For 3 bedrooms
gal. New depth 22 in.
in. Absorption rate >= 450+ g.p.d.
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off' level at
Datum Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+
Water Service line 10+
Curtain drain 50+
Manhole/Access (Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
Absorption field 5+
Water service line 10+ Surface water 100+
Building foundation 10+
Surface water 100+
Wells on adjacent lots 10+
F. COMMENTS
* Well casing goes into bedrock at 20'4".
Water main 10+
Driveway, parking/vehicle storage 10+
G. ENGINEER'S CERTIFICATION
1 certify that 1 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.
Engineer's Printed Name Steven R Pannone
Date
COSA brown sheet 10-10-12.doc
everi �i.•Pannorie:
t►�+ CE -8149
s'"
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # 131020
During a recent COSA on-site inspection and test of the potable water
supply well on Block 2, Lot 2A of High Homes subdivision, the well's
productivity was determined to be 0.35 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 3 -bedroom
residence is 0.31 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
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 ID # &5/)—��l Sj?
1. GENERAL INFORMATION
HAA # /Y4 9/O374
Complete legal description
Lot 2; Back 2; High Home Subdivi4ion;
Location (site address or directions)
Property owner Richard Mataon Day phone 694-0951
Mailing address 18734 Upppen Skytine Vnive, Eagle Riven, Alaafza 99577
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, NAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
XX
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
Holding tank
Community on-site
Public sewer
XX
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 521
5. STATEMENT OF INSPF 'ION EY 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,
Name of Firm Phone
S & $ ENGINEERING
Address 17034 Eagle River Loop Road N0, 204
Eagle River, Alaska 99577
Engineer's signature Date i' /27
1 KE—RIuHT-0E-01A-Y—t7GQUESTI-OrtlAS BEEw TEV
AS PER THE CONDITIONAL HEALTH CERTIFICATE ISSUED 10/30/91.
4
439 Ar
radte.. ' k; .� gypn
, iY a 49th •. -* Y�
11.11(/,
a., ••-.AA •) , • �4.
V. 5• • PoGkk J.91iFER. P.E.
��'s: 4(821 •SZ
6. DHHS SIGNATURE • •&
_
Approved for - bedrooms. 11a)pioFEst��j�
S i
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments At,' /7 /?/77/I/.
By: /j/i4.
IAUTION
Date /7/7l.
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. 1/9I) Back MOA k21
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 # 060 -3Q1 ' �$
1. GENERAL INFORMATION
Complete legal description
HAA # Ia (Z\ c"\ n.:.2)61‘5‘
Lo.t 2; Mock 2; High Horne. SubdZvZ&.ion;
Location (site address or directions)
Property owner
RICHARD MATTSON
Day phone 694-0951
Mailing address 18734 tippet Sky.ZLne Dt,Lve Eaq.Ce Rivet, Ak.99577
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
XX
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OP WASTEWATER DISPOSAL:
Individual on-site
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 #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.
Name of Firm $ t4 tN ,JNECRINta Phone
Address 17034 Eagle River Loop Road No. 204
Eagle River, Alaska 9951/
Engineer's signature Date
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
X Conditional approval for %lfle () bedrooms, with the following stipulations:
a0-,4-t.i~s...O-KaC r � . - CLL l
Gi� Od� /1 - k� ,c-4' t1 �a
eTt /� (/,{%..c t' t-L.c-L 6- '- •<t z.,Z.
A- ns..“)— ,f t.-etLGt /MIL /L cr t ,y1-6/-412
/}tit i4 /U' t✓ =1-� A C -
Additional Comments
ott.:
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.
r. vt'F A r='
9 nom, fi.ld
i1 .•W ,i
•
�11 9% ,, • r SS\O
E.
d
ICJ / 9�a
By: 4"–C -14-n—' -414--t
Date
CAUTION
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 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.
72-025 (Rev. IM) Back MOA a21
Legal Description:
A. WELL DATAA�
Well type f- If A, B, or C, attach ADEC letter. ADEC water system numbers.
141 / Driller G 1-1-#I17
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
1,252 .0-164\ ►M—
Parcel I.D. o So - 3
Log presentl) 1 Date completed
Total depth Cased to Or 4 I ko Casing height 12
Wires properllyy�protectedr¢*?N)
4
Sanitary sealctr/N)
Y
FROM W LL LOG
Date of test S Mi
Static water level 21
Well flow
Pump level
3�3 gpm
(iK
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Public sewer service line tJOiw
WATER SAMPLE RESULTS/
Coliform ® A., --et Nitrate
Date of sample: 0-2-1P-1 I Collected by
AT INSPECTION
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
it (.
0_
7
0
11.1
W
U
Cle
1 o_-r,l k
t3o
Other bacteria
l
B. SEPTIC/HOLDING TANK DATA
Date installed y.--1-7 -61 i Tank sizej t Compartments
Cleanouts 45a/N) %y F'tou dation cleanout N) Depression (WI?NI
High water alarm (Y/N) / � Alarm^tested (Y/N)
Date of pumping /v
Z
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Weil(s) on lot . I lei --
To property line 1004
Surface water/drainage
72-028 (Rev. 3/91) Front MOA 21
On adjacent lots
Absorption field
C,c>1k
Irl
gt
Foundation
Water main/service line
CONTINUED ON BACK PAGE
October 23, 1991
To Whom It May Concern:
As the owners of the property and residence
located at Lot 2, Blk 2, High Home Subdivision, physical
address, 18734 Upper Skyline Drive, Eagle River, Alaska, we
are currently in the process of having the portion of the
road right-of-way vacated where aur well encroaches on the
right-of-way by one foot.
October 30, 1991
Municipality of Anchorage
Department of Health &
Human Services
On-site Services Section
"-CEIVE!'
OCT 3 0 1991
,ality of Anch_: age
int. alth & Human Services
ATTN: Susan Oswald
RE: Lot 2, Blk 2, High Home Subdivision
Dear Ms. Oswald:
This letter constitutes a formal request for
conditional approval for the health authority for Lot 2,
Block 2, High Home Subdivision.
As you are aware we are currently applying for vacation
of a portion of the road right-of-way where our existing
well currently encroaches. As a condition of obtaining
long-term financing we have agreed to place into escrow one
and one-half times the amount anticipated to drill a new
well (approximately $14,900 - $15,000) in case we are
unsuccessful in obtaining vacation of the road right-of-way.
If you have any questions regarding this escrow please
contact Diana Erwin at Key Bank, 564-0206.
Thank you for your assistance in this matter.
Sincerely,
man
Richard & Kristine Matson
18734 Upper Skyline Drive
Eagle River, AK 99577
(907) 694-0951 (home)
(907) 276-5121 (work -Kris)
ASBUILT
I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
High Home Subd. 131k. 2
AND THAT NO ENCROACHLot MENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE'THE EXISTENCE OF ANY
EAEMENTS, COVENANTS, OR WHHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SEWARD & ASSOCIATES LAND 'SURVEYING 688-4566
SCALE:
1"=30'
DATE:
10-28-91
GRID:
NW 254
FB:
24-30
DRAWN:
DMS
,ov.�►aa.a d
eafect OF . ti
n�A.f.41%.
CO
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‘toDuaneMark Seward d
LS -6918 .' • ,'O
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hib a,o.*"'r
PRELIMINARY PLAT APPLICATION
Municipality of Anchorage
DEPARTMENT OF COMMUNITY PLANNING
P.O. Box 6650
Anchorage, Alaska 99502-0650
OFFICE USE
RECD BY
VERIFY OWN -
A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks.
0. Case Number (IF KNOWN)
1. Vacation Code
2. New abbreviated legal descrip ion (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34).
0
1-
Z
A
\/(
3. Existing abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOT 34) full legal on back
page.
6-
H-
0
C
5
U
13
u
2
L
0
Z
4. Petitioner's Name (Last - First)
F1
A
rs
0
N
11
A
fZ
f
Address !87 3 -- UP/'5/ -`k7'iJNE PR
VER__ State AR Y'.Y" 77
Phone No Oj1 Bill Me
6. Petition Area
Acreage
9 7
tz-
7. Proposed
Number
Lots
1
8. Existing
Number
Lots
5. Petitioner's Representative
11111111
Address _
City State
Phone No Bill Me
ROBERT C. JOHNSON
Registered Land Surveyor - 694-2543
Box 456 — Eagle River, Alaska 99577
9. Traffic
Analysis Zone
10, Grid Number
f�
S
1
11. Zone
��,,
12. Fee $ 3 •5-0-`1-`
ac 13. Community Council b62�/-e /� I (,./-4L P--
i
B. I hereby certify that (I ani) (I have been authorized to act for) the owner of the property described above and that I desire to
subdivide it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment
of the basic subdivision fee is nonrefundable and is to cover the costs associated with processing this application, that it
does not assure approval of the subdivision. I also understand that additional fees may be assessed if the Municipality's
costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and
may be have to postponed by Planning Staff, Platting Board, Planning Commission, or the Assembly due to administrative
reasons. // 2
Date' /C' G I' / %/ Gf- l` %`e--/' 4//'
cc'--6
Signature
'Agents must provide written proof or authorization.
[0-003 Front is 651
C. Please check or fill in the following:
1. Comprehensive Plan — Land Use Classification
Residential Marginal Land Alpine/Slope Affected
Commercial Commercial/Industrial Industrial
Parks/Open Space Public Lands/Institutions Special Study
Transportation Related
2. Comprehensive Plan — Land Use Intensity Dwelling Units per Acre l
Special Study Alpine/Slope Affected
3. Environmental Factors (if any):
a. Wetland b. Avalanche
1. Developable
2. Conservation c. Floodplain
3. Preservation
d. Seismic Zone (Harding/Lawson)
D. Please indicate below if any of these events have occurred in the last three years on the property.
Rezoning Case Number
Subdivision Case Number
Conditional Use Case Number
Zoning Variance Case Number
Enforcement Action For J
Building/Land Use Permit For 2n aC 05.-a %et�vr, I' — z - 3'?�
Army Corp of Engineers Permit
E. Legal description !r0L/for advertising. p
H lr-/ /- z 51/6 D /oc-k z Lo 2,
,
io„ 6 7-1�f IJ R 1w sNi,_AK,
F. Checklist Waiver
30 Copies of Plat
Reduced Copy of Plat (81/2 x 11)
Certificate to Plat
Fee
Topo Map 3 Copies
Soils Report 4 Copies
Aerial Photo
Housing Stock Map
V Zoning Map
V Water: V. Private Wells Community Well Public Utility
Sewer: Private Septic Community Sys Public Utility
20-003 Back (4,85)
VACATION OF RIGHT-OF-WAY OR OFFICE USE
EASEMENT APPLICATION
Municipality of Anchorage RECD BY
DEPARTMENT OF COMMUNITY PLANNING VERIFY OWN
P.O. Box 6650
Anchorage, Alaska 99502-0650
A. Please fill in the information requested below. Print one letter or number per block. Do not write in the shaded blocks.
0. Case Number (IF KNOWN)
1. Vacation Code
2. Abbreviated Description of Vacation (EAST 200 FEET SOME STREET)
Iz
E
R
0
0
3
7;
0
N
N
0
,6E
3.
3. Existing abbreviated legal desc iption (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOT 34).
Ft -
6
0
S
I,
p
1
L
Z
4. Petitioner's Name (Last - First)
M
Ars°N
5. Petitioner's Representative
Address I8 3 � L 2 E-1?j< ytr / N E PR, Addres, • ROBERT C. JOHNSON
R
NSON
Cit 5/46-1-E /S I VEzR Ak Fq '.7`f r�,l Registered Land Surveyor - 694-2543
YStateCity _ . 1� ^ Box 456 — Eagle River, Alaska 99577
Phone No. 674-r"9s ( Bill Me Phone No Bill Me
6. Petition Area Acreage
10. Grid Number
N zr'
7. Proposed Number
Lots
11. Zone
8. Existing Number
Lots
9. Traffic Analysis Zone
12. Fee $ < o 13. Community Council E C -E A ! VE
B. I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to
vacate it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of
the basic vacation fee is nonrefundable and is to cover the costs associated with processing this application, that it does
not assure approval of the vacation. I also understand that additional fees may be assessed if the Municipality's costs to
process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have
to be postponed by Planning Staff, Platting Board, Planning Conpmissior9, or the Assembly due to administrative reasons.
Date:
ZO-019 Front (4,85)
Signature
'Agents must provide written proof or authorization.
Z=i
C. Please check or fill in the following:
1. Comprehensive Plan — Land Use Classification
✓ Residential
Commercial
Parks/Open Space
Transportation Related
2. Comprehensive Plan — Land Use Intensity
Special Study
3. Environmental Factors (if any):
a. Wetland b. Avalanche
1. Developable
2. Conservation c. Floodplain
3. Preservation
d. Seismic Zone (Harding/Lawson)
Marginal Land
Commercial/Industrial
Public Lands/Institutions
Dwelling Units per Acre
Alpine/Slope Affected
1
Alpine/Slope Affected
Industrial
Special Study
D. Please indicate below if any of these events have occurred in the last three years on the property.
Rezoning
Subdivision
Conditional Use
Zoning Variance
Case Number
Case Number
Case Number
Case Number
Enforcement Action For
Building/Land Use Permit For
L -4,.r fl rnt T ? 6cc-t!_L .J —z..3 7/
E. Legal description for advertising. / '3 S,AT t
Uf To 3 z- ���7 / o� R,Oe lam✓, off' (-3dP,6E R
h r er-/y Sf c Z) Cs td c_k 2 f 17116-14
a ; r/ NI l:! W ,-A/) A-%,
F. Checklist
v
30 Copies of Plat
Reduced Copy of Plat (81/2 x 11)
V Certificate to Plat
Fee
Topo Map 3 Copies
Waiver
Soils Report 4 Copies
Aerial Photo
"!" Housing Stock Map
Zoning Map
v Water: Private Wells Community Well
Sewer: l/ Private Septic Community Sys
20-019 Back 04/85)
Public Utility
Public Utility
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