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HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS BLK 2 LT 1AThunderbird
Heights
Block 2
Lot 1 A
#051-721-45
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211365 PID Number: 051-721-45
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade
Name
Michael Zwalve
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
27220 Falcon Dr., Chugiak, Ak 99567
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
907-854-0007
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Thunderbird Heights 2 1A
Fill added above original grade
Ft_
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ftz
Ft.
Well
100'+
TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1250 Gal.
Surface Water
100'+
Material
Number of compartments
Lot Line
51+
NA
Poly
2
Foundation
10'+
7'
LIFT STATION
Manufacturer
Capacity
Remarks * new construction only, existing pipes unknown
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank 3034* Tank to
drainfield 3034*
Richard Person Construction
Drainfield CO/MT3034*
Inspector Crewdson Engineering
BENCH MARK (Assumed elevation) 100 ft
Inspection 15` 9-27-2021 9-28-2021
da:3`"
Location and description
2�d
9-29-202 411
Bottom of siding at BM" on drawing.
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Fnninaar'c Stmmn
Conditional Approval: Date100,
�.
.. .. d
., James A. Crewdson ; /
/ C1 j527 i
Septic System
`—
Approv �h Date o'iF`
.•.c��
'FESSIONP�'"
Note:
\\��\\�.'�►�
this approval does not include well permit requirements.
k 61i VJ/VL/ 10)
EDGE -OF ROAD
IAIATPP
SEPTIC TANK
Greer Poly 1250
BENCH MARK
100'
ELEV
FG 99.7'
INSULATION
FC
S1 DC
SEPTIC TANK
ELEV:
TOT 97.4'
INLET INV 96.8'
OUTLET INV 96.6'
PROFILE
ELEV
BOS
MH
NOT TO SCALE
Cree�rc son Engineering,_ LLC
"—
CM1 & ng
Box 671389 Chugiak AK 99567 • ce11c.1@ou0c
Celirrext:907-280-9493 • Fax: 907-688-2295
S1 UL; � CO
E DRAINFIELD / ��Q
2 '
Thunderbird Heights, Block 2, Lot 1A
Septic Tank Upgrade
Record Drawing
Prepared for: Michael Zwalve Date: 10-4-2021
Permit: OSP211365 Page: 1 of 1
ALL INFORMATION SHOWN ON THIS DOCUMENT IS THE PROPERTY OF CREWOSON ENGINEERING, LLC AND SHALL NOT BE USED FOR
ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING LLC
LEGEND
BM - bench mark
BOS - bottom of siding
BR - bedroom
C# - cleanout
DC - double cleanout
ELEV - elevation
FC - foundation cleanout
INV - invert
M# - monitor tube
MH - 24" manhole
S# - septic tank riser
SFH - single family home
TOT - top of tank
SWING TIES (feet)
A
B C
FC
1.8
18.2
MH
14.2
16.3
S1
19.1
17.6
DC
24.0
20.4
M1
11.6 16.6
C1
26.4 9.7
Thunderbird Heights, Block 2, Lot 1A
Septic Tank Upgrade
Record Drawing
Prepared for: Michael Zwalve Date: 10-4-2021
Permit: OSP211365 Page: 1 of 1
ALL INFORMATION SHOWN ON THIS DOCUMENT IS THE PROPERTY OF CREWOSON ENGINEERING, LLC AND SHALL NOT BE USED FOR
ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING LLC
LEGEND
BM - bench mark
BOS - bottom of siding
BR - bedroom
C# - cleanout
DC - double cleanout
ELEV - elevation
FC - foundation cleanout
INV - invert
M# - monitor tube
MH - 24" manhole
S# - septic tank riser
SFH - single family home
TOT - top of tank
ALLC #112279
—...
.....
- a
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Jam
A rewdson .'
C11527
��►��PROFESSIO �®~
ALLC #112279
Docusign Envelope ID: A5B2E6D0-88B9-4E43-A659-9FC0A1 C545CB
�riicnt
MUNICIPALITY OF ANCHORAGE a o�
Development Services Department r
Right of Way Section„
Department
THIS AGREEMENT, made this 13th day of October, 2021, by and between MICHAEL M.
ZWALVE and his heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the
Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the
laws of the State of Alaska, hereinafter called the "PERMITTER".
WITNESSETH:
WHEREAS, PERMITTEE is the owner of the following described real property:
THUNDERBIRD HEIGHTS, BLOCK 2, LOT IA, according to the official records
thereof, on file in the office of the District Recorder, Anchorage Recording District,
Alaska, and;
WHEREAS, PERMITTER owns and/or maintains the real property more particularly
described as follows:
The SIXTY FOOT RIGHT OF WAY OF FALCON DRIVE & THE TEN FOOT
UTILITY EASEMENT, immediately on the north and east sides of PERMITTEES
property as shown on Plat No. 1977-220, on file in the office of the District Recorder,
Anchorage Recording District, Alaska, and;
WHEREAS, PERMITTEE has placed a 6' height wooden fence for a length of 94.8 feet upon
the referenced real property which encroaches 10.8 feet upon the PERMITTER'S 60.0 -foot Right of
Way, a deck and fence upon the referenced real property which encroaches 5.5 feet and a septic pipe
upon the referenced real property which encroaches 7.5 feet upon the PERMITTER'S 10.0 -foot Utility
Easement.
NOW, THEREFORE, it is mutually agreed between the parties hereto that:
The PERMITTER, acting through the Director of Development Services
Department, hereby grants to the PERMITTEE the privilege of allowing wooden
fence to encroach 10.8 feet upon the PERMITTER'S 60.0 -foot Right of Way, a
deck upon the referenced real property which encroaches 5.5 feet and a septic
pipe upon the referenced real property which encroaches 7.5 feet upon the
PERMITTER'S 10.0 -foot Utility as shown on "Attachment A," included
herewith.
2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless,
the Municipality, its officers and employees, from any and all lawsuits, claims or
actions brought to any person for or on account of damage to property or injury,
disease, illness or death of persons, including all costs and expenses incident
thereto, arising wholly or in part from or in connection with the existence of,
alterations, maintenance, repair, renewal, reconstruction, operation, use or
removal of the encroaching wooden fence, as placed upon the PERMITTER'S
60.0 -foot Right of Way, a deck and septic pipe, as placed upon the
PERMITTER'S 10-0-foor Utility Easement.
DocuSign Envelope ID: A5B2E6DO-8889-4E43-A659-9FCOA1C545CB
3. The PERMITTEE shall not assign or transfer any of the rights granted herein to
another individual or company without first notifying and securing the approval
of the Director of Development Services Department.
4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S
real property whatsoever, except only the encroachment rights described herein.
5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days
written notice to the PERMITTEE. The PERMITTEE agrees upon such notice
of revocation, to move said encroachment(s) from the 60.0 -foot Right of Way
and/or from the 10.0 -foot Utility Easement in which it is placed. Should the
PERMITTEE refuse or fail to comply with said written notice, the PERMITTER
may, without further notice to the PERMITTEE, remove or cause to be removed
the encroachment(s), and the PERMITTEE hereby agrees to reimburse the
PERMITTER for all costs incidental to the removal thereof.
In addition to the mutual promises heretofore made, the PERMITTEE has paid the
PERMITTER a one-time permit application fee of $120.00. The PERMITTER hereby waives the
annual fee of $315.00.
IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day
and year first hereinabove written.
GRANTEE:
DocuSigned by:
10/14/2021
dUl" . Zwalve
Owner
GRANTOR: MUNICIPALITY OF ANCHORAGE
October 14, 2021
(1 Jack L. Frost, Jr.
Right of Way Supervisor
- FA L co/V
EDGE OF ROAD
N 89'53'03"E 106.90' L 1G
12.3'x16.2' SHED
z +
C o
q +
y 00
o 50' RADIUS Lot 1 A
TEMPORARY
Q- TURNAROUND 21,089 S.F.
0 x
Q W
N CHAIN-LINK FENCE
x �_
x
S 89'51'11'
FENCE
00,
5.0'x6.7' DECK-
N1
/ 2.0'
232.62'
�FCk
90,2,
2
RFS/0F�0F
P5* \
Qa 43.
S 55'05'37"E \
38.09'
-���-SEPTIC
W / PIPES
MANHOLE
/I
WOODEN FENCE
Lot 2 /
10' UTILITY EASEMENT
NOTES:
1) THE LOT IS SERVED BY A COMMUNITY WATER SYSTEM.
2) THE SHED ENCROACHES INTO THE UTILITY EASEMENT AND R.O.W. FOR FALCON DRIVE.
3) THE FRONT DECK ENCROACHES INTO THE UTILITY EASEMENT.
4) THE WOODEN FENCE ALONG FALCON DRIVE ENCROACHES INTO THE R.O.W.
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/o
PLOT PLAN __— AS BUILT _X_ SCALE 1 " = 40' GRID NW 1865 Project No 21-556fA2
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone
(907) 522-4625 Fax O F
Professional Land Surveyors ken®langsurvey.com <
.........
jonathan0longsurvey.com '9S�Q
I hereby certify that 1 have surveyed the following described property:
LOT 1A, BLOCK 2, THUNDERBIRD HEIGHTS SUDIVISION (PLAT No. 93-114)
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
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the _' Day ofLam___, _ 1__, at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plot.
?* : 49TH y*
KENNETH NG o
��csILL J�o
p Fo [5-202..' S p
0?"ieSSIONA-
AECC963
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http-J/www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211365
Work Type: SepticTank Upgrade
Tax Code Number: 05172145000
Site Legal Address: THUNDERBIRD HEIGHTS BILK 2 LT 1A G:1865
Site Mailing Address: 27220 FALCON DR, Chugiak
Owner: ZWALVE MICHAEL M
Design Engineer: CREWDSON ENGINEERING, LLC
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Pt:
Total Bedrooms:
8/27/2021
8/27/2022
21089
❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
I. Special Provisions: A Right -of -Way Encroachment permit is required for the existing absorption field partially
located in the right-of-way. Please submit a copy of the encroachment permit to close out this permit.
Received By: LI -1
Issued By: _wm/�L'
Date:
Date:
4
Municipality of Anchorage]
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services DeLiartment
On -Site Water and Wastewater Section
Waiver#: OSV211062 COSA#: Permit#:OSP211365
PID#: 051-721-45
Legal Description: Thunderbird Heights Block 2 Lot 1A
Engineer: Crewdson Engineering
Applicant: Michael Zwalve
Ncnt s
Dcparrmenr
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 0.0 feet. In addition,
your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the foundation has been approved. The approved separation distance is 5.0 feet. See
engineer's waiver request for justifications.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
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Waiver is Granted: X Waiver is not Granted:
Date: 0 �b!� Approved by: " ��s
Name of Reviewer
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MUNICIPALITY N H
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-721-45
Property owner(s) Michael Zwalve
Mailing address
Site address 27220 Falcon Dr, Chugiak, AK 99567
Day phone
Legal description (Sub'd., Block & Lot) Thunderbird Heights, Block 2, Lot 1A
Legal description (Township, Range & Section)
Lot Size 21,089 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑ Initial ❑
Single Family (SF)
Septic Tank Upgrade ED
(w/wo ADU)
(D) ❑
Holding Tank F-1Renewal EJDuplex
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Drainfield to Foundation / Drainfield to Lot Line
Distance: 5'/ 0'
I certify that the above information is correct. I further certify that
this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: _PZZS Waiver Fees: 4� 2Z�
Date of Payment: $I2 (o �oZ6� 1 Date of Payment: c• 4 ►vi
Receipt Number:0 (0 6906 Receipt Number:
Permit No. (2 PZ 11-365 Waiver No. 0)U2 I)062
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
James “Jay” Crewdson, P.E.
Email: CELLC.1@outlook.com
Cell/Text: (907) 280‐9493
Fax: (907) 688‐2295
PO Box 671389 ● 18368 Amonson Road ● Chugiak, Alaska 99567
August 25, 2021
Onsite Reviewer
Municipality of Anchorage
On‐site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99519‐6650
Reference: Thunderbird Heights, Block 2, Lot 1A
Septic Tank Upgrade and Drainfield Waiver Requests
Design Narrative
Septic Tank Upgrade: The existing 38‐year‐old 1250‐gallon steel septic tank serving the subject property
needs to be upgraded.
The proposed design is detailed on the design drawing.
The proposed septic tank upgrade, if constructed as designed;
Will satisfy all code required separation distances,
Will not cause any probable adverse impacts to adjacent properties,
Will not negatively impact existing wells and septic systems on adjacent properties,
Will not be adversely affected by potential drainage that could flow onto and off of the subject
property.
Drainfield Waiver Requests:
Drainfield to Foundation: A recent asbuilt survey shows a drainfield monitor tube that is approximately
9.6‐feet from the garage foundation. The edge of the drainfield is likely closer to the foundation than the
monitor tube and will be located while rebuilding the damaged aforementioned monitor tube. The
current separation distance has been in place for 38 years and does not appear to be impacting the
structural integrity of the garage’s slab‐on‐grade foundation. In an effort to ensure the waiver will cover
the actual distance found, we are requesting a waiver for the drainfield to be at least two times the
drainfield invert depth, 2 x 2.5’ effective depth = 5‐feet, from the garage’s slab‐on‐grade foundation. The
actual distance determined during construction will be shown on the septic tank upgrade inspection
report.
Drainfield to Property Line: While designing the septic tank upgrade, the drainfield was found to be
extending north through the 10‐foot utility easement and across the property line to approximately 5‐
feet or more into the right‐of‐way (ROW). A ROW encroachment permit request has been submitted and
is anticipated, per verbal with the ROW department, to be approved without any required changes to the
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211365, Rebecca Carroll, 08/27/21
Page 2 of 2
Date: August 25, 2021
Subject: Thunderbird Heights, Block 2, Lot 1A
drainfield. The current drainfield location has been in place for 38 years and does not appear to be
impacting utilities and/or improvements in the ROW. As such, we are requesting a 0‐feet drainfield to lot
line waiver, which will allow the current location of the drainfield to remain as‐is.
Please feel free to contact me if you have any questions.
James “Jay” Crewdson, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211365, Rebecca Carroll, 08/27/21
o S� - TI ZU.- ��1��
MUNICIPALITY OF ANCHORAGE ACCT. NO. _ w 1 A LC��
WATER CONNECTION — Location Record
ADDRESS
NAME 2 ADDITION REPLACEMENT CONN.
BLOCK �- 97 NEWCONN.
LOT 7
DATE MADE )SHOW SKETCH ON REVERSE SIPERM NQ.
SIZE�. a"r I] TYPE OF MAIN I THAW PLATE W.
CORP STOP
CURB STOP C TO C
CURB STOP C TO 1
CORP CONNECTOR
COUPLING C TO I
S BUSHING
X BRAS
X GALVANIZED BUSHING
2 pART UNION
3 PART UNION X
SERVICE CLAMP
COPPER PIPE
1 114„ KEY BOX
2" KEY BOX
THAW WIRE 6
ON n&�
CONNECTION MADE BY
31.058 (12177)
KEARNY WIRE CONNECTOR CONN.
OTHER: INSP.
PERMIT
TOTAL
EXTRA PIPE
BROKEN MAIN, EXT. CONNECTION, FT (2-3COMMENTS:
CASING. DELAYS, ETC. 6' ` � pILA
(] PAID PREY.
❑ W.M. --
13
(3 PAID CASH
[l SUB AGREEMENT
ALT. n
DISCONNECTS
Q IMP. DIST.
EXCAVATOR E
Q EXT. AGREEMENT
APPOINTMENT TIME:
TIME READY: ( #
INSPECTED BY C
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EDGE OF
F
A L CON
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L = 703 \
WOODEN FENCE 9 7'
12.3'x16.2' SHED+ / . t
.001
S 89'51'11"W 23:
Lot 2
Cb
Z . h
S 55'0\
38.09'
50' RADIUS
Lot
1 A
TEMPORARY
SEPTIC
21,089
S.F.
p PIPES
TURNAROUND
L
CHAIN-LINK FENCE
5.0'x6.7'
.62,
WOODEN FENCE
x �
10' UTILITY
EASEMENT/
x
�
x �
S 89'51'11"W 23:
Lot 2
Cb
Z . h
S 55'0\
38.09'
NOTES:
1) THE LOT IS SERVED BY A COMMUNITY WATER SYSTEM.
2) THE SHED ENCROACHES INTO THE UTILITY EASEMENT AND R.O.W. FOR FALCON DRIVE.
3) THE FRONT DECK ENCROACHES INTO THE UTILITY EASEMENT.
4) THE WOODEN FENCE ALONG FALCON DRIVE ENCROACHES INTO THE R.O.W.
PLOT PLAN ___ AS BUILT _X SCALE 1___40__ GRID --Lt—L8—K-- Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone 000O�p4�
(907) 522-4625 Fax o
Professional Land Surveyors kenOlangsurvey.comc( �F ..�q�44
jonathanOlangsurvey.com �v'\ .. ..S Q
I hereby certify that I have surveyed the following described property:
LOT 1A, BLOCK 2, THUNDERBIRD HEIGHTS SUDIVISION (PLAT No. 93-114)
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
no Improvements on the property tying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the =`-XPi _ Day of ` r 4 i___—_—_, _ �_, at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
49LH �*
KENNETH ....... ...: .o
04 �Fo ''..LS— 202.
0
4�� OFESSIONA� �o
AECC963
SEPTIC
2.0' CANT
p PIPES
W
�
n
.62,
WOODEN FENCE
10' UTILITY
EASEMENT/
NOTES:
1) THE LOT IS SERVED BY A COMMUNITY WATER SYSTEM.
2) THE SHED ENCROACHES INTO THE UTILITY EASEMENT AND R.O.W. FOR FALCON DRIVE.
3) THE FRONT DECK ENCROACHES INTO THE UTILITY EASEMENT.
4) THE WOODEN FENCE ALONG FALCON DRIVE ENCROACHES INTO THE R.O.W.
PLOT PLAN ___ AS BUILT _X SCALE 1___40__ GRID --Lt—L8—K-- Project No.
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone 000O�p4�
(907) 522-4625 Fax o
Professional Land Surveyors kenOlangsurvey.comc( �F ..�q�44
jonathanOlangsurvey.com �v'\ .. ..S Q
I hereby certify that I have surveyed the following described property:
LOT 1A, BLOCK 2, THUNDERBIRD HEIGHTS SUDIVISION (PLAT No. 93-114)
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
no Improvements on the property tying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the =`-XPi _ Day of ` r 4 i___—_—_, _ �_, at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
49LH �*
KENNETH ....... ...: .o
04 �Fo ''..LS— 202.
0
4�� OFESSIONA� �o
AECC963
MUNICIPALITY OF ANCHORAGE
1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 264A720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
Sk19GG
S CIONS fRuGf:pA)
PHONE
XNEW
UPGRADE
MAILING ADDRESS
P,
C h ,s
LEGAL DESCRIPTION
LOCATION
-Munder
_
Bird y,l +s..
NO. OF BEDROOMS
y
LiY
DISTANCE T0:
Well
e M
Absorption area
/
Dwelling
A•
PERMIT NO.
• 30
:ir1
iQ
W f
Manufacturer
Material eL
No. of comparjtnents
oC
Liq.capacity in gallons"
I a SO
IF HOMEMADE:
Inside length
Width
Liquid depth
d he
JZZ
DISTANCE TO:
Well
Dwelling
PERMIT NO.
_ _ H
Manufacturer
Material
Liquid capacity in gallons
D
W =
DISTANCE TO:
ell Foundation
Nearest lot line
/
PERMIT NO.
Onnet tJr: tfQrJ 3
a i
ti Z
FZw
No. of lines
Length of each lin ,, , Total length of lines
Trench width
Iris
Distance between lines
cc ham-
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Top of tile to finish grade M terial ben ath the
a• S
Inches
Total effective absorWn area
W
Length
Width�rlD h S /�
I�
PERMIT NO.
d H
W d
Type of crib r
Crib diamet r th
Total effective absorption area
US
DISTANCE TO:
Well 8uildi 1 ndation
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
w
DISTANCE T0:
IBuilding foundation Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
STM 3
SOIL TEST RATING g
late
INSTALLER
E -
.h AL
REMARKS
//
ten
O
0 0
W
APPROVED
9Dc� LEGAL
///J/
72-013 (Rev. 3178)
MUNICIPALITY OF ANCHORAGE
Departmentr'1 Health and Environmentar"Arotection- A)C) fir -
.825
i%.825 Street, Anchorage, AK. 1501
264-4720
Permit #. 60-369g 7 * * * HANDWRITTEN PERMIT
W62. 1MAR ON-SITE 'SEWER PERMIT
Applicant: o�c 1�j"cf Mailing Address: _P0. &0 h n4uoi.ary AKI"47
Location:T/!Al k I W •Cr,.2f Phone -Number:, /R$-2p-lf
Legal Description: L.tls/1 Lot.Size: �). pBS�FY'
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed:... I/ Holding Tank:
Maximum Number of Bedrooms: _� Soil Rating(sq.ft/br)_ 2s-�S
The Required * e,of the Soil Absorption System Is: �oI .
DEPTH •�� LENGTH `J GRAVEL 'DEPTH . . S�' WIDTH Ak
The length dimension is the length(in feet) of the trench or.drainfield. 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 is no set width for trenches.
The gravel depth is the minimum depth of gravel between.the outfall pipe and
.the bottom of the excavation(in feet).
,* * REQUIRED.SEPTIC(HOLDING) TANK SIZE'=. 2s- n GALLONS
Permit applicant has the -responsibility to inform this department during the .
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* *,* TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection.and approval by this departmen
will be subiect to prosecution.
. .
Minimum distance between a well.and any on-site sewage disposal system is 100 fee
for a private well or 150 to 200 feet from a public well depending upon the type
of public well.. Minimum distance:from.a private well.to a private sewer line
is 25 feet and to a community sewer line.is 75 feet. Well logs are required .
and must be.returned.to this department within 30 days of the well completion.
Other requirements may apply.- Specifications and.construction diagrams are
available to.insure proper installation.
* * * PERMIT EXPIRES DECEMBER 3L.1 9 3 3
I certify that:
(1) I am familiar with .the requirements for on-site sewers and wells as-
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that.the on-site sewer system may require enlargement if
the residence is. -remodeled to include more that 3 bedrooms.
Signed: Issued bye_oe— 1.
Applicant
Date:
"In the event that hIN staElon.19Insiailed M
'SWP/024 (1/81) electrical permit and Inspection must be
obtained. As-builts cannot be approved un-
til the electrical Inspection is received In this
office. The electrical work must be per.
formed by a Viceiscd olect•ician.^
Uf TCIYACITTT)F 'AKrHURAGE--_`t,�-•--
�-�+ Department of Health and Environmental protection
825 1 treet. Anchorage, AK. 1
a 269-4720
HANDWRITTEN PERMIT
m1t i� ,f,3A5,t7 "CL P*W�Oft ON-SITE'SEWER PERMIT
Iicant8. S �_ Mailing Address :.Pp,3rih)w�A�9 t1.1s
I.
inion t .(pj t4)_ ,Q_r. 2-s- Phone Number i / Rk •2 h' 3/
Al Descriptions le J P/k-27hu.iAdicsLfML Lot Sire: w2lti2b TY1
e_of-Soil Absorption System Is:
Trench: Drainfieldt Seepage Sea:. t/ Nolding•,Tankt
12
imum Number of Bedrooms t--�_ Soil Rating(sq.ft/br).rC
it . .. . . -
The Required3 Fe of the Soil Absorption System Isr �bt
.�� LENGTH JIQ GRAVEL DEPTH.___.s,§. WIDTH
4 length dimension is the length(in•feet) of the trench or drainfield. The
^pth of a trench or pit -is the distance between the surface of the ground and
* bottom of the exca'vation(in feet). There is no set width for trenches.
e gravel -depth -is the zainimtmt depth of gravel between the outfall -pipe and -
i bottom of the-excavation(in feet).
!,
§ * * REQUIRED SEPTIC(HOLDINGY TANK S17E-=:.12S:O__ GALLONS a '�
Iit applicant has the•responsibil3ty to inform this department during the
IAllation inspections of any wells adjacent -to this property and the number,
residences that the well will serve. '
` « "
'Two(2) INSPECTIONS ARE REQUIRED
Ifiliing of any system -without final inspection.and approval by this departmen
;the sub�ect--to prosecution.
mum distance between a well and any on-site sewage disposal system is 100 f ec-
+i private well or 150 to 200 feet from a public.well depending upon the type
�iblie well. Minimum distance from a private well to a private sewer line
15 feet and to a community sewer line is 75'feet. Well logs are required �
must be returned to this department within 30 days. of the well completion.
iC requirements may apply. Specifications and construction diagrams are.
ilable to insure proper installation.
* * ` PERMIT EXPIRES DECEMBER 31, 1 9 3 3 * "
certify that: _
�(1) I am familiar with the requirements for on-site sewers and wells as -
set forth by the Munieipality'of Anchorage.
(2) 1 will install the system in accordance with codes.
I(3) I understand that the on-site sewer system may require enlargement if
i the r sidence .is remodeled to include more that 3.. bedrooms.
Issued byl. i cd0 't
Applic nt
Date'..
1n the mml that t,lift'stetion is Inslsj" M
electrlcet petmit and Inapeotion twat t*
obtained. Asdauilts cannot tie epproved un-
til the dectriesl Insj)milon Is fecelvs6 In this
office. The electrical work must be per-
tormcc' by a c!cct•ician ^
SOILS LOG
i
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ TESTOLATION
825 L. Street, Anchorage, Alaska 89501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: GSK 1pevl S'Cmc:1 % by -1 '/ DATE PERFORMED:
LEGAL DESCRIPTION: Gor /, 642f ///<rdCC,QRi,ed /YGr<y'Nrs c/Bn.. S!G? ,' T/[ d, .P_ /k// S5H
" SLOPE ' SITE PLAN
DkvT
iFEE�, 1017A7 -
f'
2
f O �F1 � �'mL:-S< S'.QACc A Q.F,Oc'CGS
geovecY 6A4/4S <
i 4 r
— /asp sE / acaecbH
(cope Ar (/TE
5-s
.i
6-.
• • f16 i��eL,
7
OF: Noce.
I 8
9
10
11 WAS GROUND WATER
ENCOUNTERED? .L,,_
i•
12
IF YES, AT WHAT
DEPTH? % '}E•
13
14 *4'e') ' W,4re. G a/�
15 yct//roce0 ion
seV4CIV d4YJ o✓<rH At
16 Cr'/Aa/S'r /yd Levet.
17
18
19
e
11
1i
Reading
Date
Gross Net Depth to
Time jQntp�T� Water
Net
Drop
�ur
•• (�_'+
p - Vr.. •��r
1
1
b i
1 •,. iVim`✓
No. CL -;325 • •- J
�4 VT [• wry J✓'
•
Fp 'a•.„...•• y ;;
20 1 I PERCOLATION RATE (minutes/inch)
L.J TEST RUN BETWEEN FT AND FT
i COMMENTSA-6LFJ1 ^ferO ,cr /Il- 54 f1f XPLdPnoN CJ<ra en7-re5H ACE/C A/o c'�PCATEe
f+'c'lc�t•)nSr/ 6i('r•F ,
PERFORMED BY: awF ,e'r C ul57 dGr/A/f/ 1/P CERTIFIED BY: .G e, rcAGKs'F,R- OATE:,q/7
EX 8s-ool Sr 8S-oo2, '
72-008 (6/79)
� .r
MUNICIPALITY OF ANCHORAGE
1
Development Services Department �� Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-721-45-000
Expiration Date:
Legal description THUNDERBIRD HEIGHTS BLK 2 LT 1A
Site address 27220 FALCON DR Chugiak AK 99567
10/14/2025
Current property owner(s) WUTZKE PATRICK JOHN &SARAH DANIELL
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for
Comments or advisories:
LIM
bedrooms, with the following stipulations:
Original Certificate Date: 10/30/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval—June 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department \� ' Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-721-45
Complete legal description THUNDERBIRD HEIGHTS BLOCK 2 LOT 1A
Location (site address) 27220 FALCON DRIVE, CHUGIAK, ALASKA 99567
Current property owner(s) WUTZKE PATRICK JOHN & SARAH DANIELL Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ® Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass
Age 3 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for: Distance:
Expedited review requested: ❑
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee Waiver Fee $
Date of Payment _ U �(� y Date of Payment
COSA # VE;C 2'`"I IN 27 Waiver #
COSA Applicalion.doc
COSA Checklist.docx
COSA Checklist
Legal Description: THUNDERBIRD HEIGHTS BLOCK 2 LOT 1A Parcel ID: 051-721-45
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA - PUBLIC &/OR CLASS “A” WATER
Well log is filed with Onsite (or attached)
Date drilled Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank 50”
Date of pumping 10/14/24
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/20/83
ALL standpipes present per record drawing
Total measured depth from grade 3.8 ft (max)
Measured depth to pipe invert from grade 3.1 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective (ED).
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 10/14/24
Results Pass
Fluid depth prior to test 6 in
Water added 600 gal
New fluid depth 6 in
Elapsed time 1440 min
Final fluid depth 6 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 6 in (MOA 6” ED)
Effective depth used 6 in (Final Fluid Depth)
Effective depth remaining 0 in
(1” Fluid levels - rechecked on 10/24/24)
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears
approximately that there is 6.6” ED. No fluid levels rose in the MT, there was no fluid ever in CO invert or backed into the septic tank – levels
were constant. Fluid levels were rechecked on 10/24/24 and there was only 1” of standing fluid & assume there was heavy use at time of
testing. The system seems to be absorbing at the top of the field, and one may consider future treatment of the absorption field. Satisfactory
2021 adequacy test per MOA docs and MT was rebuilt with septic tank upgrade install at that time.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No *5 ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No *0 ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*MOA WAIVER #OSV211062 – 5’+ FIELD TO FOUNDATION & 0’ TO PROPERTY LINE TO FIELD.
IR SHOWS 10’ TANK TO FOUNDATION.
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 10/16/2024
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
10/16/24
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
www.muni.org/onsite t
Septic System Absorption Field Advisory
Certificate of On -Site Systems Approval # OSC241427
Subdivision: Thunderbird Heights, Block: 2, Lot: 1A
907-343-7904
Fax: 907-343-7997
Prior to the absorption field adequacy test, 6 inches of standing water was
observed in the absorption field. This indicates approximately 90+% of the
absorption area is inundated. Although this system passed the adequacy test, the
remaining life expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
MUNICIPALITY CIS
Development Services Department, D�;Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-721-45
1. GENERAL INFORMATION
Expiration Date: 9-119-2-02--T
Complete legal description Thunderbird Heights, Block 2, Lot 1A
Location (site address) 27220 Falcon Dr, Chugiak, Ak 99567
Current property owner(s)
Mailing address
Real estate agent
Michael Zwalve
Diane Shearer
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone 907-854-0007
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ .5-60
Date of Payment
Receipt Number 6
COSA # OSG Z 1 151 g
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Crewdson Engineering LLC Phone 907-280-9493
Address PO Box 671389, Chugiak, AK 99567
Engineer's Printed Name James Crewdson Date 8-25-2021
6. DSD SIGNATURE T WX
System #1 Approved for L Jam s A. Crewdson
S i)
y pp bedrooms
011527 i
System #2 Approved for bedrooms (�9 ' •.,,,�
Disapproved ill\XROFESS`NP��
Conditional approval for bedrooms, with the following stipulations:
c
OF,q�C/i�%
_ -SITE
WATER AND m�
SIV2 PROGRAM 6
J
By- Original Certificate Date: /©--i'. 9-2
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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Thunderbird Heights, Block 2, Lot 1A
If more than 1 septic system on lot: COSA Checklist # of
PUBLIC WATER
❑ is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments
B. TANK DATA
Age of tank(s) 0 years
Tank type/material Septic/poly
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping not required for new tank
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9-20-1983
® ALL standpipes present per record drawing
Total measured depth from grade 3.5 ft (max)
Measured depth to pipe invert from grade 3.0 ft (min)
[:1 N/A — pressurized field
IN Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 051-721-45
Structure served by this system
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
is ug/L ❑ Arsenic less than MRL (ND)
Collected
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: new tank has not filled to operating level
Adequacy test date 8-18-2021
Results E] Pass For 4 bedrooms
Fluid depth prior to test 0* in
Water added 600+ gal
New depth 0* in
Elapsed time 120 min
[Z Code -required soil cover over field
Final fluid depth 0* in
❑ System presoaked Absorption rate 600 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: *Monitor tube was only 2" into the drainrock at the time of testing. It was rebuilt wh(
the septic tank was upgraded.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
PUBLIC WATER
Septic Tank/Li non Lot > 100'
❑ Yes if No ft
Neighboring Tank > 100' ❑ Yes���ft
Absorption Field on Lot > 100' ❑ Yes if No ft
Neighboring Absorption Fields > 100'
❑ Yes if No ft
Community Sewer Main > 75' ❑ Yes if No ft
Community Sewer Manhole/Cleanout > 100'
Yes if No ft
Private Sewer/Septic Line > 25' ❑ Yes if No ft
olding Tank > 100' ❑ Yes if No ft
Animal Co
t > 50' ❑Yes if No ft
Manure/Animal Excreta Sto
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
p
Yes
if No
ft
Surface Water > 100'
Property Line > 5'✓❑
Water Main > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100'
Water Main > 10'✓❑
F. ENGINEER'S COMMENTS
Yes
if No
ft
Community Wells > 200'
❑ Yes
� � o ft
R Yes
if No ft
❑✓ Yes
if No ft
Q Yes
if No ft
Water Service Line > 10' ✓❑ 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'
it Yes
if No 7*
ft If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No
ft Wells on Adjacent Lots:
Water Main > 10'
❑ Yes
if No
ft Private Wells >100'
_ ❑Yes if No
Water Service Line > 10'
❑ Yes
if No
ft Community Wells > 200' ❑ Yes if No
Surface Water > 100'
❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
*determined while rebuilding the monitor
tube
G. ENGINEER'S CERTIFICATION ®qtr, • S 't
I certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conformance with . • • • . • ..
MOA COSAguidelines in effect on this date. . • , , • ,
James A. Crewdson ; ,r
• C11527 .•��/�
fi�F'' ....•••',.law
.
COSA Checklist yellow sheet
ft
ft
�\ Municipality of Anchorage
• -- Development Services Department ;
Building Safety Division
/.. .h.
-_ �- On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.' O s! -;-7 — H S—
COSA #
Expiration Date: 6-21-68
1. GENERAL INFORMATION
Complete legal description Lot IA: Bleak 2: Thunderbird Heights Subdivision
Location (site address) 27220 Falcon Dr. Chugiak, AK 99567
Current Property ownei(s) Earston Hewitt
Day phone 240-0686
Mailing address same
Lending agency
Day phone
Mailing address
Real Estate Agent Bennie 4-"g
Day phone 244-7176
Mailing Address
Unless otherwise requested, COSA will behold by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑
Individual On-site 0
Individual Water Storage ❑
Individual Holding Tank ❑
Community Class Well ❑
Community On-site ❑
Public Water System
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work.
4. 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. 1 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 S a s Engineeimg
Phone 694"2978
Address 15861 S. Birchwood Loop Chugiak, AK 99567
Engineers Printed Name l�d B�E-1 ` C.-vwA.✓ Date S
F
407
y ROBERT C. COWAN
'moo CE -8801
5. DSD SIGNATURE
�� Approved for _JL bedrooms. fi`OPw "EwSs�
F, r
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By; ' Original Certificate Date: `2, 1 O%
(Rw. I IM)
Municipality of Anchorage
Development Services Department
Building Safety Division
Qn-Sits Wates & Wastewater Program
4710 Bragaw, Street
P.O. Box 196850
Anchorage, AK 99519.8850
www.muni.orglonsite
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
f t hl6�Fi� �1
Legal Description: M Jig t�11�1Go2 } I eFUt1D6QB! 12 D Parcel 10: o .c i - 7 3 r -N S'
A. WELL DATA �nYt!/yt Uw
Well type CAMn If A, , or C provide PWSID #-a fru(j Well Log (Y/N)
Date completed _ Sanitary seal (Y/N) _ Wires properly /N)
Total depth ft. Cased to ft. Casing hg' (above ground) in.
FROM WELL LOG
Date of test
Static water level ft.
Well production G.P.M. g.p.m.
jWATER SAMPLE RE S:
orm colonies/100 mL Nitrate mg1L Other bactene colonkW100 mL
c: mg/1 Date of sample: _ Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material—tin-1c Z'STIML. Date installed 411W1,95
Tank size _1260 gal. Number of Compartments .42, Cleanout ( I) '4e�
Foundation deanou(IVN) Depression overtank(Y®-a High water alarm (Y& A26
Date of pumping Pumper c1 F-1`� �ymPt)t?G
C. ABSORPTION FI LD DATA
Data installed D 3 . Soil rating (g.p.d /ft= ftzJbdnn System type
n
Length g_ft. Width ft. Gravel below pipe O. 61 ft.
r9
Total depth 31 ft. Eff. absorption area Monitoring tube ES Depression over field �La
Date of adequacy test _ Results Pas ail --�� For 4bedrooms
n �r�� �
Fluid depth in absorption fleld before test .� in. Water added o-cagal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth _�in. Absorption rate >= 6,00*_ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y& type) ".) — If yes, give date =
D. LIFT STATION �{
Date installed
"Pump on" level at_ in.
E. SEPARATION DISTANCES
Sine.in gallons
Pu eve! at _ in.
Cycles tested
High water alarm level at
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO: CLA4,S /q
Septic tankAdt station on lot
Absorption field on lot
Public sewer main
On adjacent lots
Public sewer manhole/cleanout
Sewer /septic service line / Holding tank
areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
t 1 s,
Building foundation /D •f- Property line S Absorption field
Water main 10 l Water service line /D Surface water fn0 -t-
Wells
Wells on adjacent lots aft
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
r I I
Property line of Building foundation D + Water main /O --f-
Water
fWater Service line ID Surface water /d4 /I Driveway, parking/vehicle storage !D 4
Curtain drain AV" KAAftVWells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
r
I certify that I 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."'
p ktlltlR'F G eow�w wt
Engineer's Printed Name OQ &A --r Cd../d.r q Ce -`48801
Date $ 105-/07
�I` .•.4
COSA Fee $ ' 30. 040
Date of Payment S' /4/9-7
Receipt Number 9 P C
(Rev. 11!05)
Waiver Fee $
Date of Payment
Receipt Number
' MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services zTYCFA�Io
On -
Services Secon
te
P.O. Box 196650SIAnchorage. Alaska 99519-6650 �s V t � vu ON
343-4744 OCT 70 1997
CERTIFICATE OF HEALTH AUTHORITY RECE,
APPROVAL FOR A SINGLE FAMILY DWELLING C ED
Parcel I.D. It OSI — d) — r'� �lj HAA # V (QS lnil-1'_l
1. GENERAL INFORMATION
Complete legal description Lot 1; Block 2; Thunderbird Heights
Location,(site address or directions) 27220 Falcon Drive
Chugiak. AK
;Property owner, Darrell & Diane Ferguson Day phone 688-7084
Mailing address 9�27Q' Falrnn nr;v- Chug+ak, AK 99567
,Lending agency `' Day phone
Mailing address
Agent Kevin vakalis-Cornerstone Bldrs Day phone 244-8205
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: .4
3. TYPE OF WATER SUPPLY:
Individual well
Community well xxx
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site 7ocx -
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.
n.025 JP v. t/9i) Front MOA F=1
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, I verify that my
investigation 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 S b S ENGINEERING Phone 6 g Ll -'1 g 79
17034 Ea£le River Loop Road No.204
Address 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date 10 110 /17
SOF
CE -8801
bedrooms,. with the following stipulations:
Date A%
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-MM..1191) 6. MOA m
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-MM..1191) 6. MOA m
Municipality of Anchorage MUNjkjNALjTy of
DEPARTMENT OF HEALTH & HUMAN SERV10E6Nv1mNwNrALsW
Environmental Services Division ��r�TT
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-Q 10 19
0
Health Authority Approval Checklist RECEIVED
Legal Description: Idi' 1 RLa r ,2. nuammitf1 an Parcel I.D.: O $'/ — 7 a) - o S
A. wElrD@TA
Well
Log present (YM)
Total depth
anitary seal (YM)
r
Date of test
Static waterlevel
Well production
5 4 If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform
Nitrate
Data of sample: Collected by:
B. SEPTICfHOLDING TANK DATA
aifls6
Casing height (above ground)
AT INSPECTION
(YM)
Data installed 9$3_ Tank size 1Z-50 Number of Compartments Cieanouts (9N)LIM
Foundation deanout I&W) jj e, Depression(Y© Mn High water alarm (YM) �f
Date of Pumping Pumper Ta15
17-17
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.djV or ft=lbdrm) i z 5 47- System we RE D
Length. !— Width 1 Gravel thickness below pipe Total depth_
Effective absorption area Z Monitoring Tube present&) Depression over field (Y® Atn
Data of adequacy test10 1 �T— Results `J I) PASS For I'oct2. bedrooms
Fluid depth In absorption field before test (in.); Tk3.M Immediately after gal. water added (in.): D2`I
Fluid depth -- (ins) Minutes later: Absorption rate = + g.p.d.
Perkadde treatment (past 12 months) (YM) 0o,jE t=.nww*I If yes, give date
72-026 (Rev. 3196)'
D. LIFT s�+�
Date installed
Manhole/Access (Y/N)
High water alarm level at' _
Cycles tested
E. 9EPAfIATION DISTANCE;
SEPARATION OMMQ.ES
Septic/holding tank on tot
Absorption field on lot
Public sewer main
Sewer /septic service line _
Size in gallons
level at'
'Datum
FROM WELL ON LOT TO:
On adjacent lots
On adjacent lots
Public
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO:
Pump oft" level at"
Foundation t0; 4- Property line to Absorption field S /
Water main/service line(O' f Surface water/drainage t00' } Wells on adjacent lots .�IC� r
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property } lineBuilding foundation 16 � } Water maiNservice line I0 r
Surface water i0 o ' i JJ Driveway, paridng/vehicle storage area t roe
Curtain drain b1mic KNe �n1 Wells on adjacent lots Zoo' +
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municlpal record sr are
in conformance gellnes in effect on arils date.
Signature
Engineer's Name 06 CRY C. Co wq,J Y •.
/ to C. eaw�we
Data /0 l I 0 ct �j �. •. CE - 8801 r`
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. W96)'
Waiver Fee $
Data of Payment
Receipt Number
•Y
{t A
r
rr 6 ,Ire F•� A ,
g
n
r ,..
eF, } I .IV
s,
a ',A
INN
Al may' c
w
rl'
F tii S
ASetfiLT-NO COftNEF#S SE,THIS ATE• SMA5D A` SQGTA �S LAND
I HEREBY 6E=RTIrY THAT I'HAVE SURVEYED THE SCAI.c'
r • ' �,,►'ww'ti r
1=0LL6W1 G DESCRIBED PE O'PltR7Y;
�!�arr,�ur:•� D'� � •. � �'� • '•- Ri�y,a4
AND MAT NO ENCRClACHMENTS'I&IST EXCEPT AS �w ,•' ' c j %+•
INDICATED.. iTIS';THE REMNSIBILITY OF THE
OWNER TO DET'ERMIN'E THE EXISTENCE OF ANY {a};iD:' r •'••• •• +
WiriAEN�'S,'COVENANTS, 4R RESTRICTIONS iyyfrr �d3' �y
WHICH DO NOT APPEAR ON THE RECORSZ. 'tUShl . ' oue^e 7Aer} Sews d �
VISION,'PLAT. UNDER N0, CIRO MSTANG1rS SHOUI..'O F$ w , 1 �; . I5 d91 � ,te d
ANY DATA HEREON SE USED FoR CONSTRUCTI^!J '�'-�� i �' ,' r
ARY LINCE ES LINES, OR FOR ESTASLIMI3G E.
lo'd EcOMKOB 'ON Kd-1 Allv3C QNdl lvt N, Sh;t. M,3 f6-II-Nnr
oeofAneh6rageDZunicipali�
Department of Health and Human Services `
/ 825 "L" Street
Rick Mystrom,
MayorP.O. Box 196650 Anchorage, Alaska 99519-6650
October 21, 1997
Robert C. Cowan, P.E.
S b S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 1A Block 2 Thunderbird Heights Subdivision
Waiver Request 9WR970067, PID 9051-721-45, RA970473
Dear Mr. Cowan:
Your request for a waiver of the required 10 foot separation
between an on—site wastewater disposal system and a lot line has
been approved. The waived distance is 2 feet from the leachfield to
the north property line.
This approval applies to the existing on—site wastewater disposal
system lot line separation only. Any future upgrade to the 'AM'—site
wastewater disposal system will require all separations be met or'
another approval from this department.
If there any further questions or concerns regardieg this waiver, +
please call our office at 343-4744.
Sincerely,
Daniel J. Roth
Civil Engineer
On—site Services
ljw 97
n MUNICIPALITY OF ANCHORAGL
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR#j,�OglMl `1 PIN 051-721-45 HA# RA970473 Permit #
Date Received: October 10, 1997
Legal Description: Lot 1A Block 2 Thunderbird Heights
Engineer: Robert C Cowan Y E.. S & S Enaineerine
17034 Eagle River Loon Road Suite 204. Eagle River. A7acka 99577
Applicant: Darrell/Diane Ferguson
Waiver Requested: Lot line waiver of 2 foot from the absorption field to the
north property line.
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: xxxxxxx Waiver is NOT Granted:
List Conditions or Reasons for above: SEF Fy6/aEERl A7rgegED Tyt T.,Ci[A7Wy
L E7TE R
Date: October 21, 1997
Rec #: Fee Waived per DJR Amount: $
By: Pew
Name of Reviewer
Date Paid:
W.&THAUTHORITY
APPROVALS
SEWER& WATER
MAIN EXTENSIONS
SEWER & WATER
►SPEcnON
ENGINEERINGSTUDIES
ANOREPORTS
WEUHSPECTION
& ROW TEST
SORTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
eSPECTICNs
ONSITE
WASTEWATER
DSPOSALSYSTEM
DESIGN
October 10,1997
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
Attn: Dan Roth
P.O.Bor 196650
Anchorage, AK 99519
REFERENCE: Lot 1; Block 2; Thunderbird Heights
Dear Mr. Roth,
ROBERT C. COWAN, P.E.
CML ENGINEERS
(907) 6942979
FAX (907) 6941211
RECEIVED
OCT 10 1997
Municipality of Anchorage
DepL Health & Human Services
The original inspection report completed on 9/20/83 on the referenced property shows the separation
between the north lot line and the leachficid to be 8 feet. An approved HAA completed by Eagle
River Engineering on May 25, 1993 records a separation distance of 2 feet bchrcen the north lot line
and the leachfield.
We are requesting that all waiver and encroachment fees be waived since this system was documented
and approved in 1993.
If you require additional information, please contact us.
Sincerely,
Robert C.Cowin,
RCC/gk
MUNICIPALITY Of ANCHORAGt:
ENVIRONMENTAL SERVICES DIVISION
OCT 101997
RECEIVED
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577
MUNICIPALITY ANCHORAGE
• ^• DEPARTMENT OF HEALTH i£ 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
Parcell.D.# 091-771-05 HAA# tQtJ�l',f���L
1. GENERAL INFORMATION
Complete legal description Thunderbird Heights
Location (site address or directions)
Lot 1, Block 2
27220 Falcon Drive, Chuqiak
Property owner Craig & Kathleen Albee Day phone 688-0960
Mailingaddress ur 79 ach,igink AK g9S,67
Lending agency N/A Day phone
Mailing address ;
Agent Rae Hall/Great Land Realty Day phone
OF at's swel rowel ..
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
694-9125
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 X
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.
72ms1n...1n1) F, t w0A121
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 arid/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 Eagle River roginpPring Sprvineg Phone F94 -SIBS
Address P.O.' box 773294, Eagle River, AK 99577
Engineer's signature ��� Date
�6. 'DHHS SIGNATURE
X Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
M
1uTtnN
Date .S— ZS— 03
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.
72IM I WA/91) Back MOA R21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:rNUNXA,6/,CD i/EIbNTS Parcel I.D. 77,1 -40S
Lv/ / '6"ek Z
A. WELL DATA
Well type PUQL /L If A, B, or C, attach, ADEC letter. ADEC water system number
Log present(Y/N)
Date completed Driller
Total depth Cased to Casing
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER
RESULTS:
Wires properly
INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
tank
ry Nitrate
sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Other bacteria
Date installed 09/ 17,45DTank size L-
ZCompartments
Cleanouts (Y/N) %�E 5 Foundation cleanout (Y/N) YES Depression (Y/N) NG
High water alarm (Y/N) N�q Alarm tested (Y/N) NIA
Date of pumping _05//�t��9 Pumper J /Z
SEPARATION DISTANCES FROM SEPTIC/HAL=G TANK TO:
Well(s)onlot &14 Onadjacentlots Foundation )U
i AS oC[
Topropertyline IZ 14-590JET AbsorptionfieldSire.,..cLWaterrazia/serviceline -No
Surface water/drainage
72-026(Aw. 7191( Ftwl CONTINUED ON BACK PAGE
rn
rn
N
9 P m<
ao
rn
w
C
CV)
Z
Z
Date installed 09/ 17,45DTank size L-
ZCompartments
Cleanouts (Y/N) %�E 5 Foundation cleanout (Y/N) YES Depression (Y/N) NG
High water alarm (Y/N) N�q Alarm tested (Y/N) NIA
Date of pumping _05//�t��9 Pumper J /Z
SEPARATION DISTANCES FROM SEPTIC/HAL=G TANK TO:
Well(s)onlot &14 Onadjacentlots Foundation )U
i AS oC[
Topropertyline IZ 14-590JET AbsorptionfieldSire.,..cLWaterrazia/serviceline -No
Surface water/drainage
72-026(Aw. 7191( Ftwl CONTINUED ON BACK PAGE
C.. LIFT STATION
Date Installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes
SEPARATION DISMICE FROM LIFT STATION TO:
Well
D. ABSORPTION FIELD DATA
On adjacent lots
Manufacturer
chole cess (YIN)
"Pump off" level at
_ Cycles tested
Surface water _
fate installed e4o -9 3 Soil rating System type - 45E4
Length 4O Width /9 r Gravel thickness a Total depth 3
:Total absorption area %Li Cieanouts present (Y/N) Y
..Depression over field (Y/N) Nb Date of adequacy test OS/ZO/93
Results (pass/fail) _— P/1 SS for �1 / bedrooms
'Peroxide treatment (past 12 months) (Y/N) M�� If yes, give date N14
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot N1,4' Onadjacentlots f ZDa Propertyline-Z &
rWAl /1;TYd7)
i0%
To building foundation / To existing or abandoned system on lot /VIA
On adjacent lots f 30 r Cutbank MIA Watermaln/service line t /D
Surface water /V/14 Driveway, parking/vehicle storage area
Curtain drain -MING AOPMP.04T
E. ENGINEER'S CERTIFICATION
t certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect
./-/0,
date of this Inspection.
Signature — /* e�5t,4
o : 49�tt lr l
Engineer's Name_ �% �� �'+-► '�•••• �. "t;3.
Date .i/a//s J o, G' : luoi. A. Pvyr, s e
'....a. n\.
ROpFESSYOt',11,
HAA Fee $ f 7d Waiver Fee:;
Date of Payment _2/—%/3 _72Date of Payment
Receipt Number — %/ / C Receipt Number
22-M ma'. X1)8. k MOA 21
ENVIRONMENTAL OFANgiORAGE
,;VICES DIVISION
MUNICIPALITY OF ANCHORAGE ���� 2 j 7
SE
DEPARTMENT OF HEALTH & HUMAN SERVICES 198
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPRO1 D
OF ON-SITE SEWER AND WATER FACILITY ILlg'�_
264-4744
Application Date
1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
1_ / ?x./L lei-n��.iA^,2RiR�\ ;4TS.
Location (address or directions)
(b) Property Owner 4LAa ,4 1'%x Aa, Telephone: Home Business
Mailing Address
(c) Lending Institution h�cani� 5vS Mxrb�sd Telephone
Mailing Address L.ALxg Z",etr ArT�' kAzZI/
(d) Real Estate Company and Agent Cm. / t-+NOA i�AMu+YL
Address - �• �3yY "� -/l.99 r ,L. A'L 95!;'
Telephone
(e) Mail the HAA to the following address: or. Check here Mriffold for pick up.
List contact person and day phone number below.
S 8 S ENGINEERING
17034 Eagle River Loop Road No. 204
2. TYPE OF RESIDENCE
Single -Family 0�
Number of Bedrooms /
3. WATER SUPPLY
Individual Well ❑ Community ❑ „ Public ®__*�
Note: It community well system, must havewritten confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGEDISPOSAL
Onsite M_ Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 77075 ffl v 81851 From
n
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 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
Address S & S ENGINEERING
Date
Telephone - �'Sc/-25115
to-,. 1a57•1 ,
6. DHHS APPROVAL
Approved for "' bedrooms by '�' �� Date
Approved « Disapproved Conditional
Terms of Conditional Approval
� 0W
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.
Page 2 of 2 72.025 ram 8186) BACk
MUNICIPALITY OF ANCHORAGE (MOA)
LTH AUTHORITY APPROVAL (HAA)
11CtPAL p "I ALW & CHECKLIST - FEBRUARY 1984
DEPT• EtJTAL PROTECTION 264-4744
�11RONN'
319R� Legal Description: L.ci—c L
►,�uN 2 �H���a„ems /ice.
A. WELL DATA RECE�V Ep
Well Classification If A, B, C, D.E.C. Approve (Y)/ ) �� S
Well Log Present (Y/N) - Date Completed
Total Depth
Static Water Level
— Cased to
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
Depth of Grouting —
Pump Set At
Yield
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Septic/He#ding-Tank on Lot e- r_� I- ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot 250/./ ; On Adjoining Lots _
To Nearest Public Sewer Line
Cleanout/Manhole —
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HALBMIG TANK DATA
— To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Date
Date InstalledI-L� Size ,L SO No. of Compartments >
Standpipes &N) Air -tight Caps ON) Foundation Cleanout ON)
Depression over Tank (Ye Date Last Pumped -Y Cfl- r
Pumping/Maintenance Contract on File (Y/N)Ael.Dr; for
Holding Tank High -Water Alarm (Y/N) N1_4 Temporary Holding Tank Permit (Y/N) N
Separation Distances from Septic/Holding Tank:
To Water -Supply Well ��� 'E To Building Foundation
To Property Line To Disposal Field 'I'
To Water Main/Service Line. To Stream, Pond, Lake, or Major Drainage
Course —
Comments
Page 1 of 2
72 -OM IR” 8'661 RoW
r
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata / S� Type of System Design' S r-�➢Ayc 2 c`
Date Installed 5 ' Z.>- 873 Length of Field yon
Width of Field S r Depth of Field
r Gravel Bed Thickness i C,
Square Feet of Absorption Area 7��o d' Standpipes Present (6)
Depression over Field (Y/Date of Last Adequacy Test
Results of Last Adequacy Test -S A� s �sa�`'/V E12An
Separation Distance from Absorption Field:
To Water -Supply Well Z V To Property Line k2
To Building Foundation (cr ± To Existing or Abandoned System on
Lot YJ/10� ; On Adjoining Lots -30 '7e
To Water Main/Service Line rf To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course X/�a
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed Dimensions
Size in Gallons x Manhole/Access (Y/N)
"Pump On" Level at j t "Pump Off' Level at
High Water Alarm Level at Vent (Y/N)
Tested for
Electrical Codes (Y/N)
Comments
n' Check Permitted Bedroom Rating Against HAA Request ••
Pumping Cycles during Adequacy Test. Meets MOA
1 certify that I have checked, verified, orconformed to all MOA and HAA guidelines in effect on the date of this inspection.
SignedS d S ENGINEERING pate
17034 Eagle R oop o. 204
Comp"NRkwCS, 0
(o
99577 MOA No. � �— 3
Receipt No. (o V 61 (0© d3 ��/� /j
Date of Payment 'L2 1 . 6/ J
Amount:$ d
Page 2 of 2
72-0261R" 8'861 BMF
T _
6 a STEVE C0%WR. GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (9071
Addnu:
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
r
DATE: June 18. 1987
PWS I.n.o 211156
274-2533
To Whom it May Concern:
According to records on file in this office the EKLUTNA THUNDER-
BIRD HEIGHTS Water System is in compliance with the State Drinking
Water Regulations•
Sincerely,
even W. g, PE
Distri' ngineer
n
W
t MUNICIPALITY OF JWCHORAGE
DIVISION OF ENVIMZ4ENTAL HEALTH
DEPA lc7'MC OF HEALTH AND ENVIRCNME.U'I'AL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legg} Des=!pti n (irclude�gt, block, "ivis�gff ssegicn, tcwrship, range)
Locati (ad ss irect rs) �' S a v`---7-16 /1/
�- c.n e& to, �2 I Fog c o o ,y
(b) Applicants
Applicants Address
(c) Applicant is (check one) Lending Irstituticn ; Owner/builder'} ;
Buyer r=f ; Other Q (explain);
(d) Lending Institution Telephone
Address
(e) Pnal.Estate Co. & Agent
Address
Telephone 696 //94!27
2. Tvoe of Pesiderce
Sirgle-Family Multi -Family Other (describe)
Number of Bedrocrts `T'
3. Fbter Suooly
Individual Wall Ccz=nity� Public
Note: If cormnity well system, must have written. confirmation Fran the State
Department of Envircrrrental Conservation attesting to the legality andAatus.
Is the cell adequate for the amber of bedroans specified in this HAA)
4. Sewage Disposal
Orsite1 7V Public Ccrrunity Folding Tank
Is the wastewater disposal system adequate••fcr the number of bedreav Y. .1)
(Page 1 of 21
2-15-84
5.-Engireerinq Firm Providing Inspections, Tests, Data and Infcrmsticr.
I certify tha ave checked, verified, or cenfczmed to all NDA MA Guidelines in
effect on t� thi-sAnsoecticn.
Date_ ZZ -def
Nara of Firm Teleohore
$ 8 £ E:101wr Rm'.1
Address Mrs 196X
Signed by Pt!'6J4? li e��.r")�: CA���t
. Date
(ENGINEER SEAL) t`�
6.DHEP Approval
Approved for bedrooms By Date
ApprcwedOFT Disapproved Conditional
Terns of Conditional Approval _
The Municipality of Anchorage Department of Health and Envirolmmental Protection does
rot guarantee the continued satisfactory perfcrmanoe cf the water supply and/or the
wastewater disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and furs
ticral for the rumber of bedrooms and type of structure indicated.
(DIEP SEAL)
7. Nail the the lowing address;
KS2/d5/s
(Page 2 of 21
2-15-84
n ,1 L /.BZ f114Vy e41,w
MA4ANOMAW
MUNICIPALITY OF ANCHORAGE (MCA) pfP OFOHEA
HEALTH AUTHORITY APPROVAL ( HAA) ENVIRp�ENTAL PROTEC "4
CHECKLIST - FEBRUARY 1984 tgy 4'1984
A. WELL DATA R E C EIV E D
Well Classification If A, B, cc C. D.E.C. Appy ( )
Well Log Present (YIN) Date Cmpleted Yield
Total Depth Cased to Depth of Grouting
Static Water Tavel Pump Set At
Casing Height Above Ground _ Sanitary Seal on Casing (Y/1N)
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (YM)
Separation Distances frau Wall:
To Septic/Holding Tank on Lot On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected By Date
Water Sample Test Results
Caments
B. SEPTIC/HOLDING TANK DATA
Date Instal d %'3 Size /Z J — No. of Caipartaents Z
Standpipe ( Air -tight Caps Foundation Cleanou ( )
Depression over Tank ePuzapsdft_Ze_L1J
) Date Las
Pumping/Maintenance Contract on File Y �✓l for
Holding Tank High -Water Alarm (Y ) % Temporary Holding Tank Permit (YINrlig
Separation Distances fran Septic/H/o�l►dirg Tank:
To Water -Supply Well c�/;f! /T To Building Foundation 1'7 /
To Property Line p To Disposal Field
To Water Main/Service Line To Stream, Pond, Lake, or Major -Drainage
Course
Camerts &/� / .S'C�/r/LC �- ti q5eO,J
[Page 1 of 21
2-15-84
1
C. ABSORPTION FIELD DATA
Soils Rating in Abs rption Strata �2 ��jL Type of System Design _
Date Installed / L� 3 o Length of Field d-1 0
Width of Field f q Depth of Field Z
Gravel Bed Thickness
Square Feet of Absorption Area r%E r Standpipes Present
resen ( i)
Depression over Field Date of Last Adequacy Hast
Results of Last Adequacy Test /J /ra.-
Separation Distance from Absorption F d:
To Water -Supply Well CL 11SsF- To Property Line �
To Building Foundation 2 Z To Existing or Abandoned System on
Lot /J ! ,.I' ; On Adjoining Lots A/ ! /'f
To Water Y&kV oervice Line 7^-' To Cutbank(if present) X /P -
To Stream/Pond/take/cr Major Drainage Course /V 1 -1 -
To Driveway, Parking Area, or Vehicle Storage Area AvL Oq
Cawents
D. LIFT STATICN
Date Installed
Dimensions
Size in Gallons Manhole/Access (Y
"PwV On" level at M "Aad Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for ing Cycles during Adequacy Test. Meets MDA
Electrical Codes(Y/N)
Caments
** Check Permitted Bedroom Rating Against HAA Request **
I certify �ve check9d, verified, or confcru d to all MDA HAA Guidelines in effect
on the da of a'iameotiopo'—
S
KBl/d5/
ov..giiE'196X -,'C.1377 ....."t
g [r+-= proE�T. AIASYA..
pH. GC42-7, "T
(Page 2 of 21
2-15-84
DEPT. OF ENVIRONMENTAL CONSERVATION
April 27, 1984
PWS I.D. X0211156
To Whom It May Concern:
BILL SHEFFIELD, GOVERNOR
Telephone: 19071 274-2533
Addreu: 437 E Street
Suite 200
Anchorage, AK
"l�gay99501
OF ANO
PROTEMON
APR 2'1 M- 4
RECEIVED
According to records on file in this office the Thunderbird Heights
Subdivision Water System is in compliance With the State Drinking
Water Regulations.
Sincerely,
A4
mes F. Hayden
Environmental F ld Officer
JFH/msm
cc: Mr. Robert Shafer
C. Please check or fill in the following:
1. Comprehensive Plan — Land Use Classification
Residential Marginal Land
Commercial 4.1 'I'Commercial/Industrial
, , ,
Parks/Open Space Public Lands/Institutions
Transportation Related
2. Comprehensive Plan — Land Use Intensity
Special Study _
3. Environmental Factors (if any):
a. Wetland
1. Developable
2. Conservation
3. Preservation
Dwelling Units per Acre
Alpine/Slope Affected
b. Avalanche
Alpine/Slope Affected
Industrial
Special Study
c. Floodplain �—
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
Building/Land Use Permit For
Army Corp of Engineers Permit
E. Legal description for advertising. - -
's r I✓m00%, Co -r &e6z
F. Checklist
30 Copies of Plat
Reduced Copy of Plat (81h x 11)
— Certificate to Plat
X Fee
Topo Map 3 Copies
Soils Report 4 Copies
x Aerial Photo
Housing Stock Map
X _ Zoning Map
Water:_ Private Wells
Sewer: Private Septic
20-00]13 c IR" $/MMOA-24
Waiver
a' Community Well Public Utility
Community Sys. Public Utility
MUNICIPALITY OF ANCHORAGE
ECONOMIC DEVELOPMENT AND PLANNING
P.O. Box 196650 OFFICE USE
Anchorage. Alaska 99519-6650
PRELIMINARY PLAT APPLICATION RECD BY. —
S 9 4 3 5 AUG 2 1993 VERIFY OWN:
A. Please fill in the Information requested below. Print one letter or number per block. Do not write in the shaded blocks.
1. Vacation Code
C
2. Tax Identification No.
3. NEW abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34).
�9��GO���DO�G7G669�000Z�
va�o�ov��e�mmum�
4. EXISTING abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34) full legal on back page.
5. Petitioners Name (Last - First)
6. Petitioners Representative
city 'evoe State city 64 e ger state
7. Petition Area 8. Proposed 9. Existing 10. Grid Number 11. Zone
Acreage Number Number
Lots Lots
® ® FM/
9L
12. Fee S
B.
13. Community Council
1 hereby certify that p am) p 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.) 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. l also understand that additional fees maybe assessed if the Municipality's costs to process this application exceed the
basic fee. 1 fuller understand that assigned hearing dates are tentative and may have to be postponed by Plannina Staff. Plamno
Board, Planning Commission, or the Assembly due
Date:. ,6 /t /3
zo-aw ttwerenuWt.
bignature
*Agents must provide written proof or authorization.
C. Please check or fill in the following:
1. Comprehensive Plan - Land Use Classification
:; Residential
O Commercial
7 Parks/Open Space
:; Transportation Related
2. Comprehensive Plan - Land Use Intensity:
3 Special Study
3. Environmental Factors (if any):
a. Wetland
1. Developable O
2. Conservation 7
3. Preservation
Marginal Land
7 CommercialAndustrial
0 Public Lands/institutions
Dwelling Units per Acre:
O Alpine/Slope Affected
b. Avalanche
c. Floodplain 0
d. Seismic Zone (Harding/Lawson)
7 Alpine/Slope Affected
• Industrial
7 Special Study
D. Please indicate below if any of these events have occurred in the last five years on the property,
7 Rezoning Case Number.
7 Subdivision Case Number.
7 Conditional Use Case Number.
7 Zoning Variance Case Number.
:1 Enforcement Action For
7 Building/Land Use Permit For
E. Legal Description for Advertising.
F. Attached written statement in accordance with AMC 21.15.130.B. stating reasons in support of the vacation.
G. Checklist
0 30 Copies of the Vacation Request
p Reduced Copy of Vacation (8 1/2 x 11)
El Certificate of Plat
7 Fee
0 Topo Map 4 Copies
0 Soils Report 4 Copies
0 Aerial Photo
0 Housing Stock Map
B Zoning Map
0 Water: 91 Private Wells
7 Sewer: P Private Septic
20-019d1w 992' Buk
Waiver
0 Community Well 0 Public Utility
7 Community Systems 7 Public Utility
VACATION OF RIGHT-OF-WAY OR
EASEMENT APPLICATION
Municipality of Anchorage
DEPARTMENT OF COMMUNITY PLANNING & DEVELOPMENT
P.O. Box 196650
Anchorage, Alaska 99519-6650
A. Please fill in the information requested below. Print one letter or number per block.
M
iiiiii ilii iiiiii ■ .
BY:
OWN:
Tax I.D. Number
. •- - 1 •
oee�see■e�i�eeee��E�■i■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
3. Existing Abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT Al IR R1 Ica I nT ant
6ve�oeose�■oeero�o■oeoo�os�■o�re���
MENEM
Monson
5. Petitioner's Representative.
Address: SIL fo/Ca.t.
City: e1..Q� Stater
Zip Code: 67 Phone No. SBP 0Q6Q
Address:
City: C``y1o9 ce State:
Zip Code: f9s(7 Phone No. X98-Y-✓rS�
6. Petition Area Acreage. 7. Proposed Number Lots. 8. Existing Number Lots. 9. Written Justification.
® ® r
10. Grid Number. 11. Zone.
12. Fee S 13. Community Council
B. I hereby certify that (I am) (I have been authorized to act for) the owner of the propiII described above and that 1 desire to vacate 1t in conformance with
Chapter 21 OI the Anchorage Municipal Code Of Ordinances. l 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 OI the vacati, n. I also understand that additignal 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 Staff. Platting Board. Planning Commission, ort sembty��iri ahvL�.al reasons.
Date: //7� fl
20.019.8.,.. 9921- Fm t 'Agents must provide written proof or authorization.
MENEM
Monson
5. Petitioner's Representative.
Address: SIL fo/Ca.t.
City: e1..Q� Stater
Zip Code: 67 Phone No. SBP 0Q6Q
Address:
City: C``y1o9 ce State:
Zip Code: f9s(7 Phone No. X98-Y-✓rS�
6. Petition Area Acreage. 7. Proposed Number Lots. 8. Existing Number Lots. 9. Written Justification.
® ® r
10. Grid Number. 11. Zone.
12. Fee S 13. Community Council
B. I hereby certify that (I am) (I have been authorized to act for) the owner of the propiII described above and that 1 desire to vacate 1t in conformance with
Chapter 21 OI the Anchorage Municipal Code Of Ordinances. l 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 OI the vacati, n. I also understand that additignal 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 Staff. Platting Board. Planning Commission, ort sembty��iri ahvL�.al reasons.
Date: //7� fl
20.019.8.,.. 9921- Fm t 'Agents must provide written proof or authorization.
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