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HomeMy WebLinkAboutDEAL LT 1AFb777;1 Municipality of Anchorage Page of 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: 5v 9b o 3 PID Number: cfrzi;I -.2 13 Name: Wastewater System: ❑ New 0 Upgrade Address: Popov- 1 7 i Se A q ABSORPTION FIELD LA: \'J 838 Phone: t (901 -%II No. of Bedrooms: p Deep Trench ❑ Shallow Trench A BedMound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: -5 GPD/Sq. Ft. V/�f IL.S Y14bK. +'Zt Lot: Block: Subdivision: /*— Depth to pipe bottom from original grade: Gravel depth beneath pipe L V4¢.tc5 n%". ta.a Ft. O• � Ft. %� Township: Range: Section: Fill added above ^ ^ ^at ^�� o' 4rc, eA 1 Gravel length: VAtZ.I(35, m'�rl . k -),s� Ft. 95 Ft. WELL: ❑ New ❑ Upgrade Gravel width: Number Number of lines: Distance between lines: ACD S Ft. C a tion (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. CO C7 SQ. Ft. 2)303-/ 5.,4 4/0 /0✓e, Driller: Date Drilled: Static Water Level: Installer: / Date installed, Ft. N/L��c c Yield: Pump Set at: ITNK GPM Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding WS.T.E.P. To Septic Absorption Litt Holding Public/Private Manufac Capacity in gallons: From Tank Field Station Tank Sewer Lines Well' , t Material: Number artments: fes, +- Surface Water loo + 100,4 A LIFT STATION Lot + Size in gallons: Manufacturer: Line Foundation "Pump on" level at: "Pump off' level at: High water alarm at: Iv s + N4. Z „ �� „ y� „ Curtain Pump Make & Model Electrical. Inspections performed by: Drain toot + t f �o F t loo + .20 osr vb rfif�' 4.v�, 4 ee- t /-� c_ Remarks: ��,5 BENC MARK _ f `a�c.C... SP„'� �2.n�1 L+dtL�- �i -. �fi Location and Description: %L - �`ivn e .t� rail uJea"- Goy.-t•e� 4DC Assumed Elevation: /00 Ft ENGINEER'S SEAL ©p��r ATZ OF Ak v0 `� 00000� 00 ADO o© Inspections performed b �%cLJ �.����,���� ! P P y Dates: 1 st i /� 9s- -' � � � � a oa ©©0 66Q0 e® o00 00� �a O 2nd®oaa e ® aooa°o ..00e em Kenne<h P,1. D e Department of Heath an , ma Services appy vat 4�'s� �,o ; e `' 6_ 000�,1�6 as �o /rnFSPR Reviewed and approved by �'- ✓' Date- 1 0 ESQ � 72-013 (Rev. 9/91) MOA 25 •e Qo E 0 a wl C O Q J 6 I LO rlK (n I p 00'0£ 1,00'0£ 1 I a m (x3 N M i N W \ W rl- W p F- 0 L7 Z a� ED F— CL � Q ID w H V) Q Q I � � <E 3 0 w F— Q 3 I I w "� I I I ILD UI <<Mummbj W I� Q L i Cpl � LD o Z Q Q m ~LLI d amu' Z r ¢ m ca LLI 0/ LLJ Q% o LD m m Q U-) m o J I a ao a I Z "0 to u \fid I I LLI L.LI U cv AI � �o I ''/n� d J� L-D� O Q o W J \�S\� i 0 Y (U W W I ���� I I z a 114.7 I N I I m co S I Q o0 M �\ U�0om T U o ¢ o LLL �f JP21� 0'0£ ,00'0£ �6 O q p Ld I C) W 3 o rn s \ I I Q O LLJ rr) I t2 AS—BUILT DETAILS WASTEWATER ABS❑RPTI❑N SYSTEM LOT 1A, DEAL S/D w w 0 104,83 H Z/ FINISHED GRADE Fv, ,ar5.(�woJ_. SEWER R❑ IMPERMEABLE BARRIER INSTALLED Y BELOW SIDE SLOPES TO PREVENT DAYLIGHTING OF EFFLENT. w w 7 �7 ~ I SLOPE FOR FINAI 104,33 1nO' ON BED. FILTER FABRIC AND INSUL 100,66 SAND FILL VgRIES 102,40 MINIMUM 6' SEPARATI❑N T❑ B.R. VERIFIED 102.27100,67 20' 4" S❑LID FROM HOUSE oO�N - i U1 n m o oO v C) 1 1/4' PVC FROM TANK TO FIELD O r NOTES: 1. B.M. - NAIL LOCATED 2.5' FOM GRND ON TELEPHONE POLE 2. DRIVEWAY RELOCATED TO ACCOMODATE FIELD. 3, HOLES IN FIELD PLACED UP W/ORIFICE SHIELDS. O OF A ,or L� 1 * . TH� IKENNETH M. D S / ` CE -7116 �� PREPARED FOR: AO\'d WILLIAM TERRY P�FESSI��IS' P.O. Box 1778 SEQUIM, WA 98382 Q w Q U w I LL. 0 Iti Z LJ F - z z w J 2' Insulation w Z F W F F � w z¢ _ � E� l7 J J U U E 0 J LLf CL �� � rninl Ao � O 1250 GAL o S.T,E.P. cu TANK AS—BUILT DETAILS WASTEWATER ABS❑RPTI❑N SYSTEM LOT 1A, DEAL S/D w w 0 104,83 H Z/ FINISHED GRADE Fv, ,ar5.(�woJ_. SEWER R❑ IMPERMEABLE BARRIER INSTALLED Y BELOW SIDE SLOPES TO PREVENT DAYLIGHTING OF EFFLENT. w w 7 �7 ~ I SLOPE FOR FINAI 104,33 1nO' ON BED. FILTER FABRIC AND INSUL 100,66 SAND FILL VgRIES 102,40 MINIMUM 6' SEPARATI❑N T❑ B.R. VERIFIED 102.27100,67 20' 4" S❑LID FROM HOUSE oO�N - i U1 n m o oO v C) 1 1/4' PVC FROM TANK TO FIELD O r NOTES: 1. B.M. - NAIL LOCATED 2.5' FOM GRND ON TELEPHONE POLE 2. DRIVEWAY RELOCATED TO ACCOMODATE FIELD. 3, HOLES IN FIELD PLACED UP W/ORIFICE SHIELDS. O OF A ,or L� 1 * . TH� IKENNETH M. D S / ` CE -7116 �� PREPARED FOR: AO\'d WILLIAM TERRY P�FESSI��IS' P.O. Box 1778 SEQUIM, WA 98382 Q w Q U w I LL. 0 Iti Z LJ M.T. n a- KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 (907)696-6111/Fax (907)696-8111 DATE, 12-5-95 JDRAWING # NTS I 9536-S2 O w J ED 11 M U °- �v LD \ H U Q LL_ J Ln 0 d' @J .5 2.5- O LO M.T. n a- KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 (907)696-6111/Fax (907)696-8111 DATE, 12-5-95 JDRAWING # NTS I 9536-S2 DEC- 9-95 SAT 4:32 PM TWEED EXCAVATING FAX N0, 694 1250 P. I Jbg�a9:'�S, $YiT 116,:7$6 pEtgYffiNLr a_awr+... �.. —. -- .. Hcoveri ly Liohyo Electrical Gomtrac-tAM 22509 McManus ® Chuglak, Alaska 99567 Phon (9M 66"050 tr FAX* 688.6€361 t� 6W tiv� % q- pc axlp t � ��iil �������/ � ���+'�-�`.' • ` Rte`"' �lr� odpal� of Anch' -rage M �. ®`AJ Department of Health and Human. Services 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor January 9, 1996 Ken Duffus, P.E. KND Engineering 20441 Ptarmigan Boulevard Eagle River, Alaska 99577 Subject: Waiver Request for Lot 1A(Proposed) Deal Subdivision Waiver Request #WR950069, PID #051-251-13, HA950570 Dear Mr. Duffus: Your request for a waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 3 feet from the lift station tank to the north property line. This approval applies to the existing septic system separation only. Any future upgrade to the septic require all separations be met or another approval department. incerel/ ames P. Williams Civil Engineer On-site Services JPW/ljm lot line system will from this WR# WR950069 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet PID# 051-251-13 HA#�li-lid Permit # Date Received: December'll, 1995 Legal Description: Lot lA (Proposed) Deal S/D Engineer: Ken Duffus, P.E., KND Engineering 20441 Ptarmigan Boulevard, Eagle River, Alaska 99577 Applicant: William J. Terry Waiver Requested: Lot line waiver of 3 foot from the lift stat�_ion tank to the north property line of 3 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: �Jt,�r��r�r71� Date: Rec #: #01523/4366 By: Amount: $115.00 6VWW_V of Reviewer Date Paid: 12-11-95 KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11/FAX (907)696-8111 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 R EC E I W)cember 9,1995 DEC 1 1 1995 Municipality of anchorage Dept. Health & Human Services Subject: Lot 1A1. Deal S/D (Previous Lots 1-7 Deal S/D) - Lot Line Waiver Gentlemen: Although the contractor took several measurements prior to placement of the system on the subject lot, he unfortunately constructed the lift station too close to the north property line. This property line abuts an existing right-of-way. There is no street located in the right-of-way, nor does it appear reasonable that one would be constructed in the future. In addition, the available space between the well radius and the property line is extremely narrow and does not leave much room for placement of a system under normal conditions. Based on the above information we are requesting a lot line waiver for the lift station of approximately 3' to the north property line. Thank you for your consideration of this request. If there are any questions, please contact me at 696-6111. Sincerely, Ce M. Duffus, P.E. KND Engineering attachments: As -Built Details As -Built Site Plan Inspection report HAA Checklist HAA Certificate . wov-07-e5 TUE 04:07 pm KND.ENCINEERING 907 69e sill p.01 1 ^^'^-^^'^''^^^'--^^-^'^^^^^^^—^^^'-^'^^^~^^^^'^^ ^^'~^^- -^^^^^^^—^--' pcw�tkW VW sen A2141PM witbi4 the utiliV easement and under our distribution liab withiii the 'Otto -6u& property, Thig non-dbjection. is conditioged by the stipulation that NIP -A will be held harmless from and WU danmps to the encrW%=nt that may result from the existing and future U -se of nyd Gentral Man;Cger or h-0 Representative Movernbey 7. Date STATE OF ALASXA I The foregoDinuargree was acknowlad before me tW--�. day Of— Save- r paiid S. In I Is Notary Public; for the Stato -of —Al;�$" My conurission expire.% W9197 ' Post -It- brand fax transmittal memo 76711 #of P�!. NOTARVPUS= MnireWZ? STATE OF ALASKA �� ��� � � �� � �� Z& 17S6 ���\-Dept �y��l�NOV 8 19:J11-1 K8unxnpaiiY u/+o.oAo« PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE ann-'� DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 p ANCHORAGE, ALASKA 99519-6650 ON—SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT lD.c� 1\ -Ig �S PERMIT NUMBER:SW950388 DATE ISSUED:11/15/95 DESIGN ENGINEER:KND ENGINEERING EXPIRATION DATE:11/15/96 OWNER NAME:TERRY WILLIAM J OWNER ADDRESS:P.O. BOX 1178T SEQUIM, WA 98382 PARCEL ID: 05125113 �YoPL�S7�! c LEGAL DESCRIPTION: DEAL LT 3 LOT SIZE: 32365 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DURING CONSTRUCTION, CONFIRM 6 FOOT VERTICAL SEPARATION FROM BEDRC RECEIVED B ISSUED BY: DATE • DATE: �l �_ MILE 5.3 JEWEL cid jI I i 20922 _ 21126 I / / / 14 �Gj/ I / / �16 ��POtil m c O LOG KNOLL) M CANYON DR NW 957 52 Ilk 58 57 �®>- North Municipality Area Reference Map -113 Y © COPYRIGHT 1989 JMR ND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11/FAX (907)696-8111 October 10, 1995 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Lot 1A, Deal S/D (Previous Lots 1-7 Deal S/D) - Sewer Upgrade Gentlemen: The owner of Deal S/D (Lots 1-7) is attempting to recombined these lots into a single lot (Lot 1A). Currently there is a single family dwelling located on Lot 3; this house was built in 1964 and has an undocumented system serving it. As a result the owner has agreed to install a new system. We have performed several soil tests on the property. We have been able to locate a site for the new system. Due to the location of the existing well and the steep area behind the house, other potential sites have been ruled out. We will use a lift station to move effluent the distance required for well separation, and install a pressurized bed. The bed will be situated just west of the existing driveway; natural drainage is away from this site and will be maintained after construction. In order to minimize the impact of the overhead utilities and due to concerns expressed by the owner regarding bedrock we have requested the use of a 20' wide x 45' long bed. No other wells or sewer systems exist within 200' of the proposed installation. We have identified a small surface water source which crosses the property adjacent to the well and continues to the west. The proposed septic tank and bed will be over 100' from this water. If you have any questions about this application, please contact me at 696-6111 /FAX 696-8111. Respectively submitted, m ge in inn e t h . Duf , P. E. J m O attachments: On -Site Well and Sewer Application a Wastewater Absorption System Details � m 9 y Site Plan Cn ° Soils Log/Percolation Test o G) Z QO 0 J 0 11 W Uoz IZ O •8 ovlb h� 1 OJ w ,0 _J \0 xc N Pa � n � m ZzQ °' �P Q W 2:L a A WLLJ Cy� zQ H LoO LD Z CL � �D u o � I I w w o, o J �D Qd'LD I� w Z o Q o ¢ WE W N N 00.00'20" W 269.59' F- 02 02 r CO 00 V) 1 r I o I I j p N ti Q ¢ O�f Z o J P J I W C/) a- J z� O W Q hM °,ry � Pa ¢ Q F fn 1 W H W � Q W � o � hM °pry I h I — I-- V) � ryy�• o � I h"• I I\ W Uoz IZ O •8 ovlb h� 1 OJ w ,0 _J \0 xc N Pa � n � m ZzQ °' �P Q W 2:L a A WLLJ Cy� zQ H LoO LD Z CL � �D u o � I I w w o, o J �D Qd'LD I� w Z o Q o ¢ WE N N 00.00'20" W 269.59' � 02 02 r CO 00 1 r I o I I j p N ti I ¢ O�f J P J I W C/) I I I o p � N hM °,ry I I I F fn 1 Ld o � O hM °pry I h I Lo I'7 O ryy�• o � I h"• I I\ � v I I a Q 1 a O O J �• � I by I ti° I W I wcn Q1 W I p p p , c I O_ 1 w I O p yq• N ,°' 0 I I rn U) I dp }DiDn O} }U�21.U�03 00 � � I 02 02 � I � I s�� I I o,y�. I � I W Uoz IZ O •8 ovlb h� 1 OJ w ,0 _J \0 xc N Pa � n � m ZzQ °' �P Q W 2:L a A WLLJ Cy� zQ H LoO LD Z CL � �D u o � I I w w o, o J �D Qd'LD I� w Z o Q o ¢ WE N � J r CO 00 r LJ p 2:x ¢ O�f J P J QJ.oC3 W a(I:v) Q W r r r > > > w W O J W w w z O u u u i 2 X 0 Qo 1250 GALS 0 0iS.T.E.P.. NIN. Zr w TANK DESIGN DETAILS WASTEWATER ABSORPTI❑N SYSTEM W W F- a z 0 LOT 1A, DEAL S/D INSTALL IMPERMEABLE BARRIER I' BELOW SIDE SLOPES TO PREVENT DAYLIGHTING OF EFFLENT. W W F- .1 SLOPE FOR FINAL GRADE ON BED. 0 r z FINISHED GRADE (ADD UNCLASSIFIED FILL) x REMOVE ALL ORGANICS AND BACKFILL W�TTM SAND TO CREATE 6' SEPARATI❑N TO B.R. PRESSURIZED DISTRIBUTION SYSTEM HOLE SPACING DESIGN 1. RESIDUAL HEAD = 5' 2. HOLE SIZE = 3/16" = 1.00 GAL. PER HOLE @ 30 PSI 3. 30 GALS (PUMP DELIVERY)/1.00 GALS./HOLE = 30 HOLES 4. 160 LF LATERAL/30 HOLES = 5.33' SPACING PER H❑LE(USE 5.0') 5, INSTALL SPRAY COVERS ON PIPE HOLES .2' PVC FOR MANIFOLD 1 1/4' PVC FROM TANK TO FIELD S.T.E.P. O 00— C. 0. OC.❑. C.❑. 4' S❑LID FROM HOUSE OF A Ar L� TH* ...... I / KENNETH M. DU S CE -7116 W� O 1'�'iOFESSIO�P�' CAP ENDS OF PIPE ORIGINAL GROUND O u 40 LF -- F., _1 _1/4" ::_PVC W/3/16" HOLES I @ 5' SPACING (TYP) in Ln M.T. 10 DESIGN CRITERIA 45' J. 0 1. 3 BEDROOMS X 150 GAL./DAY/BEDR❑❑M = 450 GPD 2. S❑ILS RATING: 6 MIN./INCH = 0.5 GPD/SF(BED) 3. 450 GPD/0.5 GPD PER SF = 900 SF 4. 900 SF /20' W = 45 LF 5. MINIMUM DESIGN SIZE = 20' W x 45' L BED 6. 2' HD INSULATI❑N REQUIRED OVER FIELD. 7. 2' HD INSULATI❑N REQUIRED OVER TANK <4' OF COVER 8. CONTRACTOR TO PUMP TANK AND ABANDON IN PLACE. 9. CONTRACTOR WILL ABANDON OLD TRENCH IN PLACE. 10. ANY ASPHALT, CONCRETE OR APPERTANENCES DAMAGED OR DESTROYED BY THE CONTRACTOR DURING CONSTRUCTI❑N SHALL BE REPLACED BY THE CONTRACTOR AT NO ADDITIONAL COST TO THE OWNER. 11. CONTRACTOR TO VERIFY AND INSURE 2% GRADE FROM HOUSE. PREPARED FOR: KND ENGINEERING 20441 PTARMIGAN BLVD WILLIAM TERRY EAGLE RIVER, AK, 99577 P.0. Box 1778 (907)696-6111/Fax (907)696-8111 SEQUIM, WA 98382 DATE: 10-10-95 DRAWING # NTS 9536-S2 z FILTER FABRIC AND INSUL f �, / SEWER ROCK SEWER ROCK ORIGINAL GRADE SAND SILL VARIES 1_3 REMOVE ALL ORGANICS AND BACKFILL W�TTM SAND TO CREATE 6' SEPARATI❑N TO B.R. PRESSURIZED DISTRIBUTION SYSTEM HOLE SPACING DESIGN 1. RESIDUAL HEAD = 5' 2. HOLE SIZE = 3/16" = 1.00 GAL. PER HOLE @ 30 PSI 3. 30 GALS (PUMP DELIVERY)/1.00 GALS./HOLE = 30 HOLES 4. 160 LF LATERAL/30 HOLES = 5.33' SPACING PER H❑LE(USE 5.0') 5, INSTALL SPRAY COVERS ON PIPE HOLES .2' PVC FOR MANIFOLD 1 1/4' PVC FROM TANK TO FIELD S.T.E.P. O 00— C. 0. OC.❑. C.❑. 4' S❑LID FROM HOUSE OF A Ar L� TH* ...... I / KENNETH M. DU S CE -7116 W� O 1'�'iOFESSIO�P�' CAP ENDS OF PIPE ORIGINAL GROUND O u 40 LF -- F., _1 _1/4" ::_PVC W/3/16" HOLES I @ 5' SPACING (TYP) in Ln M.T. 10 DESIGN CRITERIA 45' J. 0 1. 3 BEDROOMS X 150 GAL./DAY/BEDR❑❑M = 450 GPD 2. S❑ILS RATING: 6 MIN./INCH = 0.5 GPD/SF(BED) 3. 450 GPD/0.5 GPD PER SF = 900 SF 4. 900 SF /20' W = 45 LF 5. MINIMUM DESIGN SIZE = 20' W x 45' L BED 6. 2' HD INSULATI❑N REQUIRED OVER FIELD. 7. 2' HD INSULATI❑N REQUIRED OVER TANK <4' OF COVER 8. CONTRACTOR TO PUMP TANK AND ABANDON IN PLACE. 9. CONTRACTOR WILL ABANDON OLD TRENCH IN PLACE. 10. ANY ASPHALT, CONCRETE OR APPERTANENCES DAMAGED OR DESTROYED BY THE CONTRACTOR DURING CONSTRUCTI❑N SHALL BE REPLACED BY THE CONTRACTOR AT NO ADDITIONAL COST TO THE OWNER. 11. CONTRACTOR TO VERIFY AND INSURE 2% GRADE FROM HOUSE. PREPARED FOR: KND ENGINEERING 20441 PTARMIGAN BLVD WILLIAM TERRY EAGLE RIVER, AK, 99577 P.0. Box 1778 (907)696-6111/Fax (907)696-8111 SEQUIM, WA 98382 DATE: 10-10-95 DRAWING # NTS 9536-S2 • ,d Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: _t l I TQif r' �� f 6 DATE PERFORM (ENGI OF•� rapt tPQomgon000u a 0� m o � d � 0 0 0000°oo9o4ac�°�Qeg0000(�omcoo'po 0 Kenneth M. Duffle <v CE 771¢ LEGAL DESCRIPTION: L01 I j�, V�Z:�J SLJ3 Township, Range, Section: DEPTH SLOPE SITE PLAN (FEET) 0P—C,A N 105 1 2 N 3 4 5 6 7 8 9 (f:;M 10 WAS GROUND WATER ENCOUNTERED? �S 11 S IF YES, AT WHAT S�zr L O 12 DEPTH? P E 13 Depth to Water After I Monitoring? Z Date: 14 15 16 17 18 19 20 PERCOLATION RATE y (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 2 FT AND _ FT COMMENTS b Q- D2rg .SnCL k,Q��; ( r j'() r PERFORMED BY: � t� I hP P rl LID i.._t t,'CERTIFY S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUN IPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /� A, A1- 72-008 (Rev. 4/85) ` eti'. uee°ao�0rma, �,�a,,m� )h j3 L Municipality of Anchorage'ev CD �� • ,,�; _497 T DEPARTMENT OF HEALTH & HUMAN SERVICES s `�Pd + 7 825 "L" Street, Anchorage, Alaska 99502-0650 c� ®caj9 Qe m°ao do° �o9�eo s r ee• O O O ep B� 00 0 • G� SOILS LOG — PERCOLATION TEST O va, o Kenneth ht Duf t' PERFORMED FOR:�j`o reo noopO fb J DATE PERFORIVIN tib fj LEGAL DESCRIPTION: ;:.LOQ /A De I 5 Township Range Section: Depth to Water DEPTH (FEET) �2GA N r C_ <(," SLOPE 11:57 SITE PLAN 3 ► �' /:Of Zmin 1 r � I2 ;os 2 min sg° r Z„ 2 F Nolte A 8 12'08 2�+��rl S/2" N /2'./D Waif 3y" I 112, /Z 1 2 ";P, (o n 3 GM 4 PF_ 2c Na l� t3 Q 5 LA 6- SSD RorK FRAcrUZe J- 8- 9- 9 - 10- 11 0 11 1' 12 13 14- 15- -PERc ��57 16- 17 18 19 20 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHATN / L DEPTH? /� O P E Depth to water After Monitoring? Dale: s PERCOLATION RATE —r /ry' -? (minufes,inch) PERC HOLE DIAMET7R TEST RUN BETWEEN I /2 FT AND 2 , 7— FT COMMENTS O 2 BriesQgE,7d ori,2r 40 %rLs PERFORMED BY: 1`N I �f�l7�1y� �f S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 16hJ 72-008 (Rev. 4/85) Time Net Time Depth to Water Net Drop WDateGross 11:57 3 ► �' /:Of Zmin ,i r � I2 ;os 2 min sg° r Z„ Avr f2td(o 8 12'08 2�+��rl S/2" 3y /2'./D Waif 3y" I 112, /Z 1 2 ";P, (o n s PERCOLATION RATE —r /ry' -? (minufes,inch) PERC HOLE DIAMET7R TEST RUN BETWEEN I /2 FT AND 2 , 7— FT COMMENTS O 2 BriesQgE,7d ori,2r 40 %rLs PERFORMED BY: 1`N I �f�l7�1y� �f S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 16hJ 72-008 (Rev. 4/85) • Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: B� 11 Terr �f &- 2 DATE PER FORME LEGAL DESCRIPTION: :.LO� /A Der ( S(, Township Range Section: DEPTH OP-GAN,G -/ it SLOPE SITF 1 2 3 4 5 6 7 8. 9- 10- 11 - 12- 13- 14- 15- 16 2- 13- 141516 17 18 19 20 COMMENTS fD ilp,c Nola, A �M Pe2c No(r� Q QED R,0 CK FRacrUkap t ,ic-(T� s -� l _J WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT / L DEPTH? 4,11A P E Depth to Water After Monitoring? _ Date: 7p Q 97 PERCOLATION RATE _� (minutes/inch) PERC HOLE DIAMETER _ .O TEST RUN BETWEEN 3 FT AND FT nor -to 145, PERFORMED BY: 6) Enq' 41- I 1{� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) N WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT / L DEPTH? 4,11A P E Depth to Water After Monitoring? _ Date: 7p Q 97 PERCOLATION RATE _� (minutes/inch) PERC HOLE DIAMETER _ .O TEST RUN BETWEEN 3 FT AND FT nor -to 145, PERFORMED BY: 6) Enq' 41- I 1{� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) NOV-02-95 THU 05:28 PM I KND.ENGINEERING 907 696 8111 i . ! lT, loas oao . xhx s °non ; c.a 4 2 c- ) `U { 4-71-7 1 �u..,rn {,} ",�{„7 �f��G d� �� FES �.�" C�-�9.sb,�,.z'� D►�•,�.S�c_], { cc r . � i 1 O � /• G? $ .'G� i�,�.,.{� W 4k.71 Va.�c.l,T (+(#,L� � -+, a 7-1$ �z s _ I.Gt i� L� w7! L u F i 12, P.02 m 9m nwA 351-02-95 THU 05:29 PM KND.ENGINEERING 907 696 elll tb�.A P. 03 Z0'd TITS 969 406 azd Ml 0?3H w 0. m 0.p 'v y4Q h N . TS t i r _ 93 e� a i •- r ry h F�7J LJ DNIN33NIDN3-QN> WV 92:60 IN=i 96-20-AON NOV-02-95 THU 05:31 PM KND.ENGINEERING 907 696 8111 P.06 a f FIGURE 7-30 NOMOGRAPH FOR DETERMINING WE MINIMUM DOSE VOLUME FOR A GIVEN LATERAL DIAMETER, LATERAL; LENGTH, AND NUMBER OF LATERALS i A AM NOV-03-95 09:51 AM KND.ENGINEERZNG I { i i i ploliueW Pu3 pmrn 4- 3 i w � d f lat d O N 1 h. a CD w Ls. C!1 R C7 CL Lel H aV) e. C) a zCD N rx o S cG r4 uj im U- W t� z w v W a 907 696 8111 1 e Q 8 13 e�� Q • � m . all © , eEl a Ole Bim® MEN ©o -mm o rn-piopuew ieltuao J LL 286 A � C W 0 7 z W O C N C ` CL N C. Q C 0 t7 mC'�a�7 u, E IC a'c'c x cn ro m sv c E in E O � vs NuOCL E N d R 3:70 s — c 0 N N'0 azCZa „ cu D? � .0a CL Q a� m ca .0 R P. 03 o rn-piopuew ieltuao J LL 286 A � C W 0 7 z W O C N C ` CL N C. Q C 0 t7 mC'�a�7 u, E IC a'c'c x cn ro m sv c E in E O � vs NuOCL E N d R 3:70 s — c 0 N N'0 azCZa „ cu D? � .0a CL Q a� m ca .0 R P. 03 DRILLERS NAME tug by OOC Co. dW SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 89567 s TELEPHONE 688-2769 OWNER OF LANDG G ,SL,E DEPTH OF WELL'Q i is ADDRESS _ f fi e--4 O��/� �c^,S'O�STATIC LEVEL OF WATER FT. f D LEGAL DESCRRiION.._,4 g "/f4e 6'0x.Q_ DRAW DOWN FT. DATE • Startcd Ended _ GALS. PER HR ® O PE MIT NUMBER KIND OF CASING KIND OF FORMATION-: From_j0_Ft. to Ft. 6 From Ft. to Ft. From Cp' Ft. to­f_.Ft. ,l -44 / From Ft. to Ft. Fcom_Ft. to_Z—OFt, From Ft, to Ft. From —72 Ft, to 7. Ft. ',Q�saG�C' �iC%�pLit�,fs✓ From Ft. to Ft From Ft. to Ft.— -� From Et. to Ft From 73 rt. to, 6:0 . Ft. - ja*C_ o&o !®crC _Q0 el p From Ft. to Ft. From Ft. to Ft. From Ft, to Ft. ' From Ft. to Ft. From Ft. to Ft. From Ft. to Et From Ft. to Ft. Front Ft. to Ft. Ecom Ft. to Ft. " From—Ft. to ' Ft. From—Pt. to Ft. From Ft, to Ft. From Ft. to —Ft. From Ft. to—Ft. Frani Ft. to Ft. From—Ft. to Ft. From Ft, to Ft. From Ft. to —'Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Et - From Ft. to Ft. From Ft. to—Ft MLSCL. INFORMATION: m . " u 7 � � �� 6/ -.1 i DEC 190)5 ( l ; MUflicipality of Anchorage Dept. Health & l urnan Services DRILLERS NAME ®Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-251-86 Expiration Date 1. GENERAL INFORMATION: Complete legal description DEAL S/D• LOT 1A Location (site address) 17933 OLD GLENN HIGHWAY CHUGIAK AK 99567 Current Property owner(s) FIRST NATIONAL BANK OF ALASKA Day phone N/A Mailing address PO BOX 100720 ANCHORAGE AK 99510 Real Estate Agent PETE CARPENTER Day phone 854-8404 r 1� 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 --- 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number Oe -70: COSA # '05C` 1� 15--7q Date: Waiver Fee $ _ Date of Payment Receipt Number 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: tZ e? 0 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on 4he property 'in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for -� bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, 0 u Kl�)" 40 T �........... . .......... ......... I f A. Gar ess.: —79 OQ4 S .•�c�G •� 0 O 4Q4ed pl Z(� •��� F'�o �o esskor c� #AECC884 ON-SITE WAT,. ARID _ o WASTE`' E; ATER z 1J�,0 SEROGG\��\ Original Certificate Date: 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. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet_10.10.12.doc Nitrate Advisory C Arsenic Advisory Other c Legal Description: DEAL S/D; LOT 1A If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 12/81 Total depth 80 ft Cased to 16.3 ft (TO BEDROCK) ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 11/21/19 1 of 1 Parcel ID: 051-251-86 Structure served by this system 1 Well production at time of test 4.0+/- gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate *9.49 mg/L ❑ Nitrate less than MRL (ND) Arsenic ND ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 11/12/19 Static water level at beginning of test 11.8 ft. Comments "POINT OF USE FILTRATION SYSTEM LOCATED ON KITCHEN SINK. SAMPLE TAKEN BEFORE FILTRATION SYSTEM. B. TANK DATA Age of tank(s) 24 years Tank type/material STEEL C. LIFT STATION ❑ Required maintenance completed Age of lift station 24 years Measured operating fluid level in septic tank '37.25" Lift station material STEEL ❑ Standpipes/foundation cleanout per record drawing Comments: *TANK PUMPED AND HOUSE HAS BEEN Date of pumping 08/06/2019 VACANT SINCE JUNE PER REALTOR. NOTE: FOUNDATION CLEANOUT AND LIFT STATION CONTROL PANEL LOCATED INSIDE BASEMENT OF HOUSE. SEE ATTACHED PHOTO. D. ABSORPTION FIELD DATA PRESSURIZED BED Which system tested (date installed) 11 195 Adequacy test date 11122J19 ❑ ALL standpip'es.present per record drawing Results R Pass For 3 bedrooms Total measured depth from grade 3.7 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade ft (min) Water added 517 gal ❑ N/A — pressurized field _ New depth 0 in On Monitor tubes go to bottom of effective. If not, state Elapsed time 0 min depth into effective IMMCode-requiredsoil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ gpd o (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) UNK date of test) Gallons introduced *2 �9 gallons If yes, enter date Comments/Deficiencies: `1,328 GALLONS ADDED TO DRAINFIELD THROUGH THE LIFT STATION AND PUMPED TO DRAINFIELD ON 11/21/2019 AND AN ADDITIONAL 1,021 GALLONS ADDED TO THE DRAINFIELD ON 11/22/2019 PRIOR TO SEPTIC ADEQUACY TEST. NOTE: NEW MONITORING TUBE INSTALLED IN SOUTHERN CORNER OF DRAINFIELD ON 11/27/2019 BY ARM SEPTIC SERVICES. NEW MT WAS SET TO 6" DEEPER THAN INVERT OF DISTRIBUTION LINE AND THE EXISTING MT WAS WITHIN 1" OF THE SAME ELEVATION AS THE NEW MT. THE DRAINFIELD HAD INSULATIONIFILTER FABRIC OVER IT WITH 2+ FEET OF COVER PER ARM SEPTIC SERVICES. COSA Checklist yellow sheet E. SEPARATION DISTANCES WITH CAVEAT - UNABLE TO VERIFY SEPARATION TO EDGE OF DRAINFIELD TO WELL. PER 1995 INSPECTION REPORT, DRAIFIELD IS 100'+ FROM WELL. *UNABLE TO VERFIY SEPARATION FROM WELL TO PRESSSURIZED SEWER SERVICE LINE. From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑ Yes if No Septic Tank/Lift Station on Lot > 100' Surface Water > 100' Q Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑ Yes r❑ Yes if No ft ❑r Yes if No ft Neighboring Tank > 100'✓❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No **UNK ft Absorption Field on Lot > 100'❑ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' ft If septic tank is under driveway comment below Animal Containment > 50' ❑✓ Yes if No ft Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5 + ft Surface Water > 100' Q Yes if No ft Property Line > 5' ❑ Yes if No **3 ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' El Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' r❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' El Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *MET SEPARATION DISTANCE AT TIME OF INSTALLATION. **LOT LINE WAIVER GRANTED (#WR950069) NOTE: LETTER OF NON -OBJECTION GRANTED FROM MEA FOR SEPTIC SYSTEM (SEE ATTACHED). G. ENGINEER'S CERTIFICATION / certify that / 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. COSA Checklist yellow sheet #AECC884 LOT 8 LOT 15 �Q� LOT 7 i _ JEWEL STREET 370.7' m N890 59' 00"W 617.41' 17.730.2' LIFT C❑ 00 y�P= STATION <,,Sf 700/j / co ✓ 0C 386.5' .... .::... ... . CENTERLINE EXISTING MFA POWERLINE /fig, EASEMENT EXTENDS 15' EITHER SIDE, BLM MTP SUPP. PLAT FOR 000078. T1 5N R1 W, SEC 20, A021429 N890 59'49"E 703.35' J� TRACT G-1 NOTES: 1. THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN. WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. 2. ELEVATIONS ARE GAAB 72. 3. ZONING IS CE 11. 4. LOT AREA IS 191,969 SQUARE FEET (4.4 ACRES) PER MOA PROPERTY CARD. �� . inc I ORDERED BY: ROB CAMPBELL 250 H Street Anchorage, Alaska 99501 Survey Department Phone 562-5291 Mainline Phone 243-8985 AECC 668 LEGAL DESCRIPTION: LOT 1 A, DEAL SUBDIVISION DRAWN DATE: 12/2/2019 DRAWN BY: AP CHECKED BY: SC SCALE: 1" = 100' WORK ORDER: 19111 PLAT: 96-4 GRID: NW957 FB/PG:815/57 REF: 93 4D 208.5' EXISTING HOUSE SEE DETAIL M LOT 1A TRACT 2 AS -BUILT LEGEND: ..r:',tir� Gravel CLEAN OUT 0 C❑ WATER WELL ® a Cpnuet FENCE —X—X— Overhar POWER POLE Wood De GUYWIRE ELEVATION 0 m 426.0' ili W 0 CD 0 CD CD CD Z HOUSE DETAIL 24g, FFE = 404.8' AT DOOR r1, 4 OJp� �v a 1.7' A8' 5.3- 2.0' 2.0' a ' .0, SCALE: 1 " = 20' TRACT 1 OF•A��gs�p p�P49TH�� ........................... c STEVEN CALLA16HAN ; r ZLS 12034 � •5J Qa � fZ- 2- • • a v ��essiono1 _� 111 ADDRESS: 17933 OLD GLENN HWY. PARCEL#: 015-251-86-000 SURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST OTHERTHAN NOTED. EXCLUSIONARY NOTE: IT ISTHE OWNERS' RESPONSIBILITY TO DETERMINETHE EXISTENCE OFANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF-WAYTAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LINES, OR FOR PLOT -PLAN PURPOSES. MUNICIPALITY OF ANCHORAGE Development Services Department s Phone: 907-343-7904 On -Site Water & Wastewater Section -� Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner ,PAT- (,rNAL RA,N Street Address Septic Tank: u,,a,�� -Sludge level d inches -Pumping: required yes no -Pumping completedono Lift station: -Pump basket cleaned lano -Effluent filter cleaned no -Control floats cleaned M no -Proper float settings confirmed no -Operation satisfactory e no Alarm System: -Dedicated electrical alarm circuit Q no -Audible and visual alarm inside dwellinges no •Alarm system operatio vr'sati actory not satisfacto Manhole Riser -Ground water intrusion at riser to tank connection yes o -Ground water intrusion around pipe penetrations yes -Weep hole functional es no -Manhole lid: Functional �9 no Insulated �o Properly Secured es no Other -All manufacturer required inspections and maintenance completed Z520 Comments: T�- Qualified Maintenance Provider: J Technician :W 0j4t*hCwX(,J Date of maintenance Company Iyv� SignatureDate t�.Jat /,q Nitrate Advisory Certificate of On -Site Systems Approval # OSC191S79 Subdivision: Deal , Lot: 1A 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 9.49 milligrams per liter (mg/Q. 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. 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. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. .dj, . ............ . . mix Mail�r<gyArl" rens P Bo3c 196650Anc��ra�ge AIasTCa'+''y5�965rs *www mum orgWNS �..u.x�"v..+.��r .,rt..„...:=.,i",�...�t�„ i ,:..��,.,i�M < ,v,a:t .�,�;x,..r�`:�.o�.vs,xa�4��.�3.t�,,.���°�..-. �a:.:�.a.S:4i�s:.�..:;�'��,�.:".a.F.�:��t 5,'a;.�, R�'�.�tr,�, -.., �t,.�✓ex5`�, � ��;�:A.�..,�s �:�:, a`,n54'. Septic Tank Advisory Certificate of On -Site Systems Approval #OSC191579 Subdivision: Deal Lot, 11A Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 24 years old. Typical replacement costs range from $8,000 to $11,000. 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 20 year old steel tank MAY look like. Municipality of Anchorage PAGE evi • Development Services Department r Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. S A E T Y P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel HAA # "010�19D Expiration Date: = G — O 1. GENERAL INFORMATION Complete legal description Lot 1 A, Deal Subdivision Location (site address or directions) 17933 Old Glenn Highway Current Property owner(s) Elwood & Peggy Daw Day phone 694-5779 Mailing addresst�t.> 2au'770`7402-j C. 2 A- 4 8577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑X Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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. STAT81VIENT 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 Health Authority 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. S 8. S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 904 Phone 9 y - a 1 7 9 Address Eagle River, Alaska 99577 Engineer's Printed Name Robert C. Cowan, P.E. Date /1 /0 / GINEE �� ROBERT C. COWAN 5. DSD SIGNATURE /� s CE - 8801 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: OF API&r� r� V '. • WATER AND_ Additional Comments J PROGRAM .; •/�(` �JJJ�JI J,������ Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: G - 2 6 -Cil (Rev. 12100) Municipality of Anchorage o Development Services Department I t _ - Building Safety Division < _ - On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904• HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: , � Parcel ID: A. WELL DATA Well type`& •VAT�_- Date completed I0/ Total depth _0D�_ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal(ON) Cased to 7-7 f3��2oG IL FROM WELL LOG 1 Z I 10 ft. WATER SAMPLE RESULTS: a Coliform colo114 nies/100 ml. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5 )�' 9 -13.1 -11 - Nitrate mg./I Collected by: Well LogN) Wires properly protectedo) 1) cif t Casing height (above ground) in. AT INSPECTION _ & �J g.p.m. Other bacteria colonies/100 ml. 170?ft v aOl= MVc.r ► Oran S:Gac; No. 20 a 1p ivly: r, Aiaslca 99577 L_ Date installed II �� c f Tank size I D- gNumber of Compartments 2 Cleanouts C/N) Y � Foundation cleano •) �z 5 Depression over tank (YN n c High water alarm (Y% ) �f� J Date of pumpi �� i 0 1 Pumper 42 J C. ABSORPTION FIELD DATA Date installed I/( 6� Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length `� ft. Width :�_10 ft. Gravel below pipe ft. Total depth j ft. Eff. absorption area ?a ft' Monitoring tube Depression over field No Date of adequacy test 17i Results (Pass/Fail) AFor 3 bedrooms Fluid depth in absorption field before test ,L,2 in. Water added gal. New depth (o in. Elapsed Time: d min. Final fluid depth Jzin. Absorption rate >=_ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) IV19AI& /�IV If yes, give date D. LIFT STATION Date installed he Sire in gallons.--. Z� v "Pump on" level at - in. "Pump off' level at in. Datum' M 17P-i�/1/4-1- Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SepOic station on lot LD-,) Absorption field on lot l 40 i Public sewer main /`/ A Sewer /septic service line ZS r� Manhole/Access &N). High water alarm level at _ in. Meets alarm & circuit requirements? i On adjacent lots ITU r` On adjacent lots /�70 Public sewer manhole/cleanout N ,A" Holding tank N SEPARATION DISTANCES FROM SEPTIC/H9-0t11G TANK ON LOT TO: r / Building foundation �J / -� Property line .3 Absorption field Water main�( Water service line /0 -�- Surface water /00 r - Wells on adjacent lots 4 00 i1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line f Building foundation / O Water main Water Service line d Surface water /CO Driveway, parking/vehicle storage F Curtain drain /fDN& Wells on adjacent lots —10e -IL- F. COMMENTS G. ENGINEER'S CERTIFICATION c� , _/ ••..1-y f, I certify that / have determined through field inspections and j, a; r t;�', • : rF, review of Municipal records that the above systems are in :S. conformance with MOA HAA guidelines in effect on this date.E °: •-� m )i �'y-`-! C, C ��'' ;� ,�, , � Mr rp COWAN � �� Pa0 t Engineer's Printed Name AV Date HAA Fee $ 3 0 V y Waiver Fee $ Date of Payment r 3^ A) / Date of Payment Receipt Number S Receipt Number (Rev. 12/00) JUN -26-01 15:11 FROM-CT&E ENVIRONMENTAL SRV Ak CT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 1013597002 S & S Engineering NA Lot IA Deal S/D Drinking Water 0 9075615301 T-243 P.03/05 F-204 Client PO# Printed Date/Time Collected Date/Time Received Date/Time Technical Director Released Hy A h 06/26/2001 14:57 06/22/2001 12:00 06/22/2001 15:30 Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results PQI., Units Method Limits Date Date Init Waters Department Nitrate -N 2.53 0.500 tng/L EPA 300.0 Microbiology Laboratory Total Coliform 0 0 col/lOOmL SM18 92228 (<10) 06/22/01 SCL (<I) 06/22/01 SKW O 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 1. D. #y i — ! — ` HAA # �� �(� 61 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Pro ert owner `�J' n` _ Day phone Mailing address ii-7� Lending agency Day phone Mailing address Agent t� Day phone Address ��u �r rrn ; YrEr _t-, tom` -2, t AG° rk Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water K 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 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 furtherverify 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 KND Engineering Phone 1�4 ice- i i i c: j ;-.arm)gar. divd, Address Eagle Fiver. AK 99577-87W Engineer's signature %�����-%�- Date 6. DHHS SIGNATURE Approved for bedrooms. By: Disapproved. Conditional approval for Additional Comments te T�v^ c� ,3 auo •�+3stl=ase axe n S.3 r A. -I VS .. tV. ics._.= bedrooms, with the following stipulations: 11171 r', 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. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 ok Health Authority Approval Checklist Le p 1 Description: P 14 �1 ezL� � 3 ��rL. Parcel I.D.: OSI- 2S)- 1.2, ���� �-• IA Lois 1—% 47O-0,L�� � "^' mA. WELL DA a > cn Well type It7 If A, B. or C. attach ADEC letter. ADEC water system number rn -. Log present (Y/N) y Date completed 12 11<{ I3 n Total depth ` ' ` P cgC� Cased to Ih q Casing height (above ground) Z Sanitary seal (Y/N) �� Wires properly protected (YIN) FROM WELL LOG AT INSPECTION Date of test Static water level to 10 , Well productionS 4( g -P -m. m. SK Qfoc�A� g•P Sir lnol gE3a�JG3.a c��r�. WATER SAMPLE RESULTS: rno i Coliform O Nitrate o`Z • a � Other bacteria � Date of sample: I I I l S 14 S Collected by: K-nb eery B. SEPTIC/HOLDING TANK DATA Tank size Number of Compartments Cleanouts (Y/N) Foundation cleanout (YIN) Depressio High water alarm (Y/N) Date of Pumping Pumper C. ABSORPTION FIELD DATA 1 Date installed I1 I� 26 �4.s Soil rating (g.p.d./ft' or ft2/bdrm) 0.5 System type d - Length I'S Width z cD Gravel thickness below pipe 0.5 ` Total depth- o�. cawc2�. Effective absorption areaII q� � Monitoring Tube present(Y/N) Depression over field (Y/N) t� Date of adequacy test � e -W 'Ex -45. Results (Pass/Fail) A � For 3 bedrooms Fluid depth in absorption field before test (in.); -- Immediately after — gal. water added (in.): — Fluid depth _ (ins.) Minutes later: — Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes- give date D. LIFT STATION Date installed 111 1 R I G S Size in gallons I Z Manhole/Access (Y/N) "Pump on" level at* L(pi-'I "Pump off' level at* / ,t High water alarm level at* 7 It *Datum 3oTi m .4 i e.,�IL Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot N /p- ; On adjacent lots Absorption field on lot I ce:, I + ; On adjacent lots Public sewer main I On 4- Public sewer manhole/cleanout Sewer /septic service line Lift station L r- r SEPARATION DISTANCES FROM ON LOT TO: Building foundation s'+ loo %+ Property line 3 ' +A Absorption field we Water main/service line 7-5'-- Surface water/drainage I oo + Wells on adjacent lots Liz= 4- ieL , y� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation to ,--I- Water main/service line Surface water I00% 4- Driveway, parking/vehicle storage area Curtain drain t oe' +- Wells on adjacent lots F. ENGINEER'S CERTIFICATION Io'4- Propertv line I c, o `-I 1 certify that 1 have determined thru field inspections and revietiv of Allunicipal records t404, s stems are in conformance u4th N10A fL4.4 guidelines in effect on this date. �; OF A/ �� q Signature A. Engineer's Nameell,—, 17-67% /y[ 3 . CJ�.�S °'`V '�`� �G" °'°�e�Wff Date /�iAP S'- �?� ;:err ,n ,e,. L)u T- 'crn ®� /C-- 7116 \a HAA Fee Date of Payment Z —��` 7LS Receipt Number 1 �) 0,:) Rev. 8/95 OSS: haa.wk.doc ------------------------- — z as sem-- �pROFESSIS����~ Waiver Fee $ W) f Date of Payment Receipt Number Z s� (!VO" NORTHERN TESTING LABORATORIES, I. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 2.77-8378 • FAX 274-9645 KND Engineering 20441 Ptarmigan Blvd. Eagle River, AK 99577 Attn: Ken or Dee Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: A141978 Deal Subdv. Hosebib - Rear House Water Report Date: 11/27/95 Date Arrived: 11/20/95 Date Sampled: 11/18/95 Time Sampled: 1600 Collected By: * Definitions * ND = Non Detected H = Above Regulatory Max. E = Estimated Value M = Matrix Interference D = Lost to Dilution MDL = Method Detection Limit Lab Date Date Number Method Parameter Units Result * MDL Prepared Analyzed ------------------------------------------------------------------------------------------------ A141978 EPA 353.3 Nitrate -N mg/L 2.29 0.50 11/24/95 Reported By:✓✓✓Anthony J. Lange Chemistry Supervisor MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Date: October 30, 1995 To: Zoning and Platting Division, CPD Fro ��mes Cross, P.E., Program Manager, On-Site/Water Quality Subjec : Request for Comments on Cases due 10/27/95. The Environmental Services Division, On -Site Services Section has reviewed the following cases and has these comments: S-9834 Deal Subdivision. The septic system currently being permitted must be constructed and documented prior to approval. S-9835 Prator. No objections. S-9836 Hillcrest. No objections provided all development is served by public water and sewer. MUNICIPALITY OF ANCHORAGE ® COMMUNITY PLANNING AND DEVELOPMENT P.O. Box 196650 Anchorage, Alaska 99519-6650 PRELIMINARY PLAT APPLICATION A. Please fill in the information requested below. Print one letter or number per block. OFFICE USE RECD BY: 9 92�t1 1. Vacation Code 2. Tax Identification NP. 1 3. Street Address 0 5 ❑ 151411 M0 1-�I lel v "? D -J_ , 1 (, - 1, 1 Is Ir e z 0-5/ 25 65 4. NEW abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34). 5. EXISTING abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34) full legal on back page. 6. Petitioner's Name (Last - First) ®®®®N©Ie®e®®I®11111 11111111011111111111 Address D0 WOK 2,-1 City Phone 8. Petition Area Acreage MINNOME MENNEN State�� Zip 9`i5.?tl 9. Proposed Number Lots 001 7. Petitioner's Representative Address y `/G' City c /I o -C 41 Gr State Phone # 61 :'_-s �-' <;/ Zip c` �-o 10. Existing Number Lots ■�. ■ son 11. Grid Number 13. Fee $ 5 ��A 0^ 14. Community Council MENNEN 111111 B. I hereby certify that (I am) (1 have been authorized to act for) the owner of the property described above and that I desire to subdivide it it 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 alsc understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. I furthe understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff, Platting Board, Planning Commission or the Assembly due to administrative reasons. Date: 2 Signature "Agents must provide written proof oauthorization. 20-009 Front (Rev. 9i92) ' C. Please check or fill in the following: 1. Comprehensive Plan — Land Use Classification :x- Residential Commercial Parks/Open Space Transportation Related D 2. Comprehensive Plan — Land Use Intensity Special Study 3 Environmental Factors (if any): a. Wetland 1. Developable 2. Conservation _ 3. Preservation Marginal Land Commercial/Industrial Public Lands/Institutions Dwelling Units per Acre 41 Alpine/Slope Affected Alpine/Slope Affected Industrial Special Study b. Avalanche c. Floodplain d. Seismic Zone (Harding/Lawson) 2 Please indicate below if any of these events have occurred in the last five years on the property. Rezoning Case Number Subdivision Case Number Conditional Use Case Number Zoning Variance Case Number Enforcement Action For Building /Land Use Permit For Army Corp of Engineers Permit _. Legal description for advertising. Checklist 30 Copies of Plat Reduced Copy of Plat (8'/2 x 11) Certificate to Plat Aerial Photo Housing Stock Map Zoning Map 6 Water: ® Private Wells Sewer: Private Septic 0.003 Back Rev. 9192) VVI Fee Drainage Plan Topo Map 3 Copies W Soils Report 4 Copies Pedestrian Walkways Landscaping Requirements Community Well Community Sys. Waiver Public Utility Public Utility VACATION OF RIGHT-OF-WAY OR EASEMENT APPLICATION Municipality of Anchorage DEPARTMENT OF COMMUNITY PLANNING P.O. Box 6650 Anchorage, Alaska 99502-0650 VERIFY OWN: AFFIDAVIT: POSTING. 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 Tax I.D. Number o9--- 0 2. Abbreviated Description of Vacation (EAST 200 FEET SOME STREET). 3. Existing Abbreviated legal description (T1 2N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOT 34). 5. Petitioner's Representative. Address: - 1902 -2-Z/ ��s Address: �1%/% Vy� ac7 �N��'� City:vG,UOM, State:_ CityGV,1A61Z-, State: �11 Zip Code: �2- 5" Phone No. w9 ©4✓`✓" '2 Zip Code: 9J`© 3 Phone No. 6. Petition Area Acreage. 7. Proposed Number Lots. 8. Existing Number Lots. 9. Written Justification. 10. Grid Number. 11. Zone. Nva 12. Fee $ 13. Community Council 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 cost 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 St ff, Platting Board, Planning Commission, or e Assembly due to a inistrative reasons. Date: 2 Signature 20.019 (Rev. 4/92)' Front 'Agents must provide written proof or uthorization. C. Please check or fill in the following: 1. Comprehensive Plan - Land Use Classification A Residential O Marginal Land O Commercial O Commercial/Industrial Cl Parks/Open Space O Public Lands/Institutions O Transportation Related O Alpine/Slope Affected O Industrial O Special Study 2. Comprehensive Plan - Land Use Intensity: Dwelling Units per Acre: �- O Special Study O Alpine/Slope Affected 3. Environmental Factors (if any): a. Wetland O b. Avalanche O 1. Developable O 2. Conservation O c. Floodplain O 3. Preservation O ,2Dd. Seismic Zone (Harding/Lawson) 0,1- D. . Please indicate below if any of these events have occurred in the last three years on the property. O Rezoning Case Number: O Subdivision Case Number: O Conditional Use Case Number: O Zoning Variance Case Number: O Enforcement Action For O Building/Land Use Permit For E: Legal Description for Advertising. 07- 1- GJL v ; L o-- -7 F. Checklist O 30 Copies of Plat O Reduced Copy of Plat (8 1/2 x 11) O Certificate of Plat O Fee O Topo Map 3 Copies O Soils Report 4 Copies O Aerial Photo O Housing Stock Map O Zoning Map O Water: O Private Wells O Sewer: O Private Septic 20019 (Rev. 4/92)' Back Waiver O Community Well O Public Utility O Community Systems O Public Utility Ell nA ?I