Loading...
HomeMy WebLinkAboutTURNAGAIN BLK 2 LT 13Onsite File Turnagain Block 2 Lot 13 #016-122-41 i~ ~ MUNICIPALITY OF ANCHORAGE / ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION '~ ~.'~ ~li~ 825 L Street* Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ~EW MAI LING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~00 O IF HOME--DE: ~ ~ ~ DISTANCE TO: Well Foundation , Nearest lot line PERMIT NO.~ ~Z~ ~ No. of lines~ LenCh of each llne~d~ 5~d / Tot~l length of lines¢ ¢, Trench widt~ ~ inches Distance betwee//~ lines ~ Building foundation Sewer llne Septic tank Absorption area(s) OTHER SOIL TEST RATING .~ 0¢ REMARKS (907) 243-2282 KEN JOHNSON KEN'S COMPANY WATER WELL DRILLING PUMP SALES & SERVICE 30 YEARS ALASKA DRILLING 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 September 10, 1982 Robert Traeger P.O. Box 4-679 Anchorage, Alaska 99509 REo Lot 13 BLK, 2 Turnagain Subdo ( H 349-2357 W 276-3522 ) WATER WELL LOG 0 ft to 15 ft 15 ft to 20 ft 20 ft to 40 ft 40 ft to 52 ft 52 ft to 62 ft 62 ft to 70 ft 70 ft Sand with trace of fine gravel Brown silt Sand & brown silt Gray sand silt ( weeps H2o ) Clay Dirty Silty sand ( weeps ) Fine and Medo sand with fine gravel Water bearing Static 30 ft from top of casing Test pumped 3 hours at 14 Gpm Drawdown to 54 ft. T0C ( 24 ft. DD Clean & Clear Set pump al 60 fto from top of casing Sug~e~st 10 GPM pump PERMIt NO~ 8PPLIC[aNT BOB TR[aEGER LOC[aTION FOUR PLE~ LEGRL 'LimB2 TURNRGRIN TYPE OF SOIL RBSORPTtON SYSTEM IS: ,~.-, STREET~ C~--S ITE I-'llJN I C: T PI-:tL I T'-~-' OF I-'---II'-.IOHORRFJE DEPARTMENT r'~. HE[aLTH [aN[>[aNCHOR[aGE,ENVIRONMENTAL'[aK. 99bO'l'-XOTECTION 4741 M[aRS }45-1- 4 LOT SIZE 999999 SQU[aRE FEET~ 125 ~ TRENCh M[aXIMIJM NUMBER OF BEDROOMS = 8 SOIL R[aTING (SQ FT/BR)= THE REQUIRED SIZE OF THE SOIL [aBSORPTION SYSTEM IS: DEPTH= iCI LEI'-,I GTH= :9,4 ~-~RR%"E L [:'EPTH= 6 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DR[aINFIELD. THE DEPTH OF Ia TRENCH OR PIT IS THE DIST[aNCE BETWEEN THE SURF[aCE OF THE GROUND [aND THE BOTTOM OF THE E>~'C[aY[aTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GR[aYEL DEPTH IS ]'HE MINIMUM DEPTH OF GR[aVEL BETWEEN THE OUTF[aLL PIPE [aND THE BOTTOM OF THE EXC[aV[aTION (IN FEET). PERMIT 8PPLIC[aNT HBS THE RESPONSIBILITY TO INFORM THIS ~EP[aRTMENT DURING THE INST[aLL[aTION INSPECTIONS OF [aNY WELLS [aDJ[aCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENOES TH[at THE WELL WILL SERYE. T~40 ( 2 7.. I r-ISPE~---~T I O~-IS Ft~:E REL~L~ I RED B[aCKFILLING OF [aNY SYSTEM WITHOUT FINIaL INSPECTION [aND [aPPROY[aL BY THIS DEP[aRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DIST[aNCE BETWEEN Ia WELL [aND [aNY ON-SITE SEW[aGE DtSPOS[aL SYSTEM IS ±00 FEET FOR Ia PRIV[aTE WELL OR i50 TO 200 FEET FROM Ia PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DIST[aNCE FROM Ia PRIV[aTE WELL TO Ia PRIVATE SEWER LINE IS 25 FEET [aND TO Ia COMMUNITY SEWER LINE IS 75 PEET. OTHER REQUIREMENTS M[aY [aPPLY. SPECIFIC[aTIONS 8ND CONSTRUCTION DI[aGRAMS 8RE [aV[aIL8BLE TO INSURE PROPER INST[aLL[aTION. F'ERI'~I I T E::<P I RES DEiZ:EI~IBER _~'1~ :1.982 I CERTIFY TH[at t: I AM F[aMILI[aR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS las SET FORTh BY THE MUNICIP[aLITY OF [aNCHORAGE. 2: I WILL INST[aLL THE SYSTEM IN [aCCORDRNCE WITH THE CODES. 2: I UNDERSTBND TH8T THE ON-SITE SEWER SYSTEM M8Y REQUIRE ENLRRGEMENT IF THE APPLICANT V4.~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~ SOILS LOG - [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9- 10- 11 · % SLOP~ WAS GROUND WATER .ENCOUNTERED? OATEPEREORMED= b't~O'~ SITE PLAN i 13- 14- 15- 16 17 18 19 20 S E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE [minutes/inch) COMMENTS .~/~/-~__~; -- TESTRUNBETWEEN -- FT'AND FT ~ lZ~ ~,/~,~,~,~, .~,~,~-J~., -t~, /ff,~ ~_.~.~r;. .ERE~RMEOSV: G~-~ /~'.~.~.. CERT,~,~D.V: :~-r DATE: 72-008 (6/79) 0 ~ \0©' .5. B9°S'7 /V. c~9° s7 'W, ~O~ LOT SURVEY CERTIFICATION Lot z~-~-, Block :--_~2~-~ Area - Sq. Ft. -E LEGEND: Brass Cop Monument Iron Pipe Sleel Pin -~Z-_6(..L"~J'VZ'1 ~'ATZ~=Lgb,',gDTL~/SZQTV_EE ~ survey Heb ~ Tqck Plat File No. ~P:~ Zoning District ~== Ancho, a o Record ng D stnut, Alaoka · 'g ' ' ' · ~ - LU~VVL)~'~;-(~':? ~ ........ ~d-~r'%~,';~'~--'i --:-/-7~ :- 7-~:-~: ~'/¢=:-=~-'':==::==:~ .... ~ ~. fi-.. t' ...... /..~k HEF~LTH ~i",![::, EN',,,'! RON!"!ENTFIL,,--~b3TEC'T t: ~ H ; ', '" c," ,~:-: [ '/ .... , p.- '"'"[ .......... F'- -N_,PL d-..:!b FIK. , ,"~ , ......... ', ~ :,IF..~[ ..... ~ 2 eq 4 - 4 7 2 ~3 ~,~ ~:C L. L_ f~ P-~ IE::,, ~.':E~ ~'-4 --- :'~.; TE. ']" EE ?2; EE ~.-~ E~ lE4~ [::= ~ EE~ ~',,~ % ]- PERH):T NO. (' ':': ~*: .... ..... = d L, *~-.*=- NF'F'~ 'r F:RN]" LOCRT I ON L. EGFiL F'F!E:FN'T TRaE6ER 474t FiI"3RST, DRIVE 9~.!!]~EI7' t 'TT 't2 BLOCK ':2 q IJ~j' IH _,[-I ] i',t ~,,.'"[., LOT .......... , d-E OF '::;'"il HE,_:_,JB., TIUN .[=,: FIFIF:;:i:MUH NUHBER CiF BEDIqtEIOM'Z(; = 4. 2;0 Z L, NI'-IT .[ THE REQUIRED :,.[,:..:~ OF' FHa:. =,...;IL. Ia[.3':SORF']"ION '"',,,'"' ]'FIE LENGTH E)ZMENL::;ICd'.,i IS THE LENGTH (IN FEE:~ OF ]'HE TRENCH OR DRFIINFIEL. D. THE DEPTH OF R 'I"RENCH OR F'ZT IS:, THE DISTR!" E:ETHEEN THE SURFF/CE OF THE OROL!ND FIND THE BOTTOf"I OF THE E',,4CFIb'FITION FEET). THERE )iF_'; NO SET klIDTH FOR TRENCHES. THE GF;:RVEL. DEPTH :[:5 'THE HZNtMLIH DEPTH GRFI'¢EL BE]"I.4EEN THE OUTFRLL. PIPE Fff'4L":, THE ~,.. I_,fl OF THE ~--LH F'ERH :[ T Fi[:'[:'[_ ;[ CANT HFiS THE REtBP Z NE; I E i L :( ):NSTRLLFH'ION INSF'ECTI ONE; OF laN'?' NELL NUMBER (:IF REE]tE:,ENC:ES THFI-F THE HELL. E[FiCKFZLL]:NG '"F FII",;'¢ _ ..... I Ell b~):THOUT F,F'PRF'THE:hrT ....... 1.4~LL u_']F: E;UE',..:rEC:T T-_ F'R HZNIHUM DISTRNCE E:ETHEEN R 1,4ELL :'LEiE~ FEET FOR R F'R:[VFFFE HELL O[ FI UPON THE TVPE OF F'UE:LZC HELL S F'R' L. INE Mll'.4II','!ljh'l [:,IE;TFtNC:E F'I:~:OM A PRI',,,'i HELL. TO FI TO FI COMMUF,~ZT'¢ :SEHER LZI'IE IZ:~ 75 FEEE'T. HELJ_ ESi'5 ~RE REQUJ:RED ~ND .tS-F E~EE RE'TLIRNED TC ]"HE D~'F]RTMENT OF T.4E HELL COMPL. ETION. .......................... FEb]., ZC. HT.[LN... RND CONSTF "iTI'"IErP ~'f:5 ZF'F'hlF"IT'g F'IIa'9 FIF'[ ¢. ,:r, ~. ~ ': , h,-F~ Z N:gTF!LLF~T I ON. r~,~ ...I_.HE,__ TO T~.,!':;It~'E' ~'g','"'"~ ! CERT!F"r' THRT ±: I Ri'"! F'RHILIRF:.' HI"FF REQUIREMENTS FOR ON-S;I'TE SE!.qERS FORTF! B'?' THE MLtNtCIF' IT'9 OF RNCHORRGE. 2: I HiLL INS'TRLL Sh-'S;TEM IN RC:CORDRNCE HITH THE CODES. 21:: I UNDER2;TFtND THR-F THE ON-SITE 5EFIER SYSTEM MR'9 REQUIRE RESIDENCE IS REHO[:,ELED TO INCLUDE MORE THRN 4 BE[:,ROOHS;. :T .~,ND THE: E: ]: GNE[:,: F~F'PL T. ] Fi.kiT F4.':OBERT ]"RFIE ]iER · MUNICIPALITY OF ANCHORAGE Department~ ~ealth and Environmenta~rotection ~ ['~ 825~ Street, Anchorage, AK. J9501 264-4720 - * * * HANDWRITTEN PERMIT * * * Pe~t #~O~ WELL AND/OR ON-SITE SEWER PERMIT Address: Location: Phone Number: L~gai Description: ~ ~ ~ ~_~ 'T~a~ Lot S~ize: Type of Soil Absorption System Is: .Trench: ~ ,Drainfield: Seepage,'Bed: Holding T~nk': Maximum Number Of-Bedrooms: ~ Soil Rating(sq.f~/br) /~ · he Required Size of the Soil Absorption System Is: DEPTH ~a .BEN~H_ L-~ GRAVEL DEPTH ~ WIDTH The Z~ngth dimension is the length(in feet) of the trench or drainfieId-. The depth of a trench or pit is the-distance between the surface of the ground and the bottom of the excavation(in feet). There ms no set width for trenches. The gray'el depth is the minimum depth of gravel between tke outfall pipe and ~he bottom-of the excavation(in feet). · ~ REQUIRED SEPTIC(HOLDING) TANK SIZE': /~L.~-C~ GALLONS * * Permit-a,pplicant,has the responsibility to inform this depar:men~ during the installation inspectzons of any wells ~adj,acen~ to this property and the number of residences that the well-will serve. · * * 'TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of and'system without final inspection and approval by this department will be subjec: 5o prosecution. Minim0_m~istance between~a well and any on-site sewage disposal system i~ 100 feet for a private ~ell or 150 to 200_feet from a public well .depending upon the type of public well. Minimum d'istance ~from.a .privat. e well to a private sewer line is 25 feet and to-a community sewer line is 75 ~eet. Well logs are required and~must be returned to.this department within 30 days of the well completion. O~her requiremenEs ~y ~pply. Specifications"and construction diagrams are a~ailable ~o insure proper i~stallation. · ~* * PERMIT EXPIRES DECEMBER 1 9 8 2 * * * I certify that: (1) I_'am familiar with ~ke requirements for on-site sewers ~nd wells as set forth bF the Municipality Of Anchorage. (2) I will install the system in accordance with codes. (~3) I understand that the on-si~e sewer- system may~re~ulre enlargement if the residence is .remodeled to~ include more that~_bedrooms. - . -Sig~e~: Issued by: ~ ~~ ~-- Applicant Date: SWPZ024(1/81) CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION. PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of public water system located , Alaska, submitted in accordance with 18 AAC 80.100 .nave been reviewed and are [] approved. · ' []conditionally approved (see attached conditions). · ? ,-? .,-.~' '~,~-~ ~ ....... ~:...lL -~ .~(~ DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change fcontract order no. Approved by Date The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. BY TITLE DATE As-built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. TITLE DATE GREAI'EF ANCNO!'.~ L AREA BOROUGH '~.,, ~. HEALTH DEPAkTt'IENT ~_.~-~ CASE ~ ,,, %' T> 327 EA~LE STREET ANCHORAGE~ ALASKA 99501 This Form Repomts a: So~ls Log ~ , .Percolation Test ........ Depth Feet 12 ---:"" Soll Characteristics Was Ground Water Encountered? If Yes, At What Depth Location Sketch Reading Date Gross Time Net Time Depth To H20 Net Drop Proposed Instal~Seepage Pit ~ Drain Field th · ' ......... rep Of Inlet Depth To Bottom Of Pzt Or Trench__ COMMENTS: ~ ....... MUNICIPALITY OF ANCHORAGE 0 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 016-122-41 1. GENERAL INFORMATION Expiration Date: &o S , a? C) u Complete legal description TURNAGAIN BLK 2 LT 13 Location (site address) 1210 E 112th Ave Current property owner(s) CLAIR LAWRENCE pay phone 378-2333 Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) 0 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic ❑ Water Storage ❑ Holding Tank : ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer E Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 220 Waiver Fee $ r Date of Payment _�p jJ�l•24� Date of Payment Receipt Number Receipt Number COSA # Ds«GI a3o Waiver # COVID-19 2590" DISCOUNT APPLIED 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address rr11-1 Box 770724, Eagle River PO Engineer's Printed Name Steve Eng Date +�P�� OF AC '44 Ar Ar A9 Ili* 6. DSD ioSIGNATURE N HN" l I'� i aa System #1 Approved for bedrooms #, Ar System #2 Approved for bedrooms F U Disapproved Conditional approval for bedrooms, with the following stipulations: OF \N N1 lklep, ?10 By: Original Certificate Date: 0A/ 0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. rAl 0 Will 1361111 �Ik COSA Checklist Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory'.. Arsenic Advisory Other Legal Description: TURNAGAIN BILK 2 LT 13 Parcel ID: 016-122-41 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Al Well log is filed with Onsite (or attached) Well production at time of test 7+ gpm Date drilled 9/10/82 Water storage tank volume 0 gallons Total depth 70 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 70 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic 5:19 ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by NRim Eng Date of flow test for COSA 5/19/20 Date of Sample 5/19/20 Static water level at beginning of test 29 ft. Comments Absorption Field Decommissioned- Possible. Septic Tank Not Located- Assumed Decommissioned B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results 0 Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if COMMUnity well) Septic Tank/Lift Station onLot >10O' F�Yea ifNoft Community Sewer Manhole/Cleanout >1UO' F-1YesifNoft F1 Yes ifNoft Property Line �>5' [�Yea ifNoft ifNoft Neighboring Tank �>1OO` P/1 Yes ifNoft Absorption Field �>6' Private Sewer/Septic Line �> 2S`F7lYes ifNoft ifNoft Absorption Field on Lot >1OO' F-1YesifNoft Fl Yes ifNoft Water Main �>1O' Holding Tank �>1OO' Yeo ifNoft Neighboring Absorption Fields �>1OO' F-1 Yea ifNoft Water Service Line �>1O` Animal Containment >�5O' 7Yes ifNoft ifNoft 7Yea ifNoft Manure/Animal Excreta Storage�> 100' Community GevverMain �>75' F/�Yea ifNoft R] Yes ifNoft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations �>1O' F�Yea ifNoft Surface Water �>1OO' F1 Yes ifNoft Property Line �>5' i |Yee ifNoft Wells onAdjacent Lots: Wells onAdjacent Lots: || Yea Absorption Field �>6' | |Yaa ifNoft Water Service Line >1O' Private Wells �>1OO' Fl Yes ifNoft Water Main �>1O' El Yea ifNoft El Yes Community Wells �>2OO' F-1 Yea ifNoft Water Service Line �>1O` El Yes ifNoft |fseptic tank isunder driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation �>1O" F�Yes ifNoft If absorptionfield iounder driveway comment below Property Line �>1O' F-1 ifNoft Wells onAdjacent Lots: Water Main �>1O' || Yea ifNuft Private VVeUa�>1OO' F] Yes ifNoft Water Service Line >1O' Fl Yes ifNuft Community Wells �>2OO, MYee ifNoft Surface Water �>1OO' El Yes ifNoft F.ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of Municipalrecords that the above systems are /nconformance with MOA COSA guidelines in effect on this date. COSAChecklist yellow sheet E. 112th AVENUE 0 6 to S 89'57'E 80.00' GRAVEL n WELL N ASPHALT 24•x36• _ 4.2'x11.7' STORAGE - CARPORT 4.2'x11.7 STORAGE CONCRETE WALKWAY CONCRETE WALKWAY 5.8•x18.0' DECK Qw O < a O O �� Lot 12 Lot 14 � I I I ON Z 36.2' I215.0' ---- 4 LJ ROOF OVERHANG CHAIN-LINK FENCE— Lot 13 14,400 S.F. 0) 0i SEPTIC PIPE -----` N 89'57'W 80.00' ----- ALLEY NI ----------- ------ I I I I Lot 3 Lot 2 Lot 1 I I i PLOT PLAN ___ AS BUILT _X_ SCALE _1" =40__ GRID _ SW 2632__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in c , (907) 522-6476 Phone 000pOpOO (907) 522-4625 Fax oo Professional Land Surveyors kenOlangsurvey.com cO.F.Aq(�Q jonathanOlangsurvey.com I hereby certify that I have surveyed the following described property: QCij: 49TH LOT 13, BLOCK 2, TURNAGAIN SUBDIVISION (PLAT No. P-232) 0 Anchorage Recording District, Alaska, and that the improvements situated thereon are �•"" within the property lines and do not encroach onto the property adjacent thereto, that !7 no Improvements on the property lying adjacent thereto encroach on the surveyed �'A' KENNETH .. .. premises and that there are no roadways, transmission lines or other visible 00 0 easements on said property except as Indicated hereon. Q s� rj�20 Zb •'� Dated this the OQ PFa LS— 202.•' yJ4G __2� _ Day of ___lib t_________, _��' 2 ° _, at Anchorage, Alaska 04 pRaFES ..... moo It is the responsibility of the owner to determine the existence of any easements, 4��Do00o�� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 I APPLI~"~NT FILLS OUT UPPER HA[r"~ONLY ' Address Zip Code Address Zip Code Realty Co. & Agent Phone Street Locatio~ Type of Residence [] Single Family ~Multiple Family No. of Bedrooms [] Other Water Supply /~ Individual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. · Community For wells driPed prior to that date, give well depth (attach Icg if available). [] Public Utility Sewer Dlsposa~ i ¢~ $7 D. [] Public Ulility When Gonnected to P~hli¢ Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notesl _ m'~/ ~UNICIPALITY OF ANCHORAGE PFPT 0~ !i. Ei~ ~ 0 ~982 RECEIVED ~ ~-) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ' ) CONDITIONAL APPROVAL* Soils Rating Date ~wer installed Well To ~sorption Area ¥~ j~ f Well Log Received / ~-F~ ~ .5> ~- ~' ~ Well to Tank / ~ ~ ' Septic T~k Size 72.023(3/~)