Press Alt + R to read the document text or Alt + P to download or print.

No preview available

The URL can be used to link to this page

Home My WebLink AboutLOFTY HEIGHTS LT 1A1Lofty Heights Lot 1 A 1 #017-411-34 Municipality of Anchorage Department of Health and Human Services iy' Building Safety Division w - Oo-Sile Water and Wasteater Program, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Pagel of 2 www.d.anchorage.sk.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWSW020137 PID Number: 017-411-34 N.m. Wastewater System: ❑ New ® Upgrade Pper Huffman Road (14516 ABSORPTION FIELD Pkww euro. of Bewawo.: 14 2 D DwP Tn O Shen" Tnodi ❑ Bed O Mo xw ®Deer Tank LEGAL DESCRIPTION San Rwba ToW Depen bm o," pr.ae Block Let 6.1,*Aw : D.Vm b pip bodwe Or m or" dnd. Qrdwh bww"b pipe. Tow"" Ramp S.cbon: FA.dded.baw onakui Inde' - Ft Gnu Lengm. Well: New ❑ Upgrade Gr.wiwm: Nn of &w. DWw�o.b. k. : I R Fl cwuf bwi mrl w . B. Q TOW D.MGaed b: ToW abMOrPboa w. Rq M" w Exi in Fl. Fl W 1 3034 PVC taa.r Due DOW' Sbbc Www Level. knt"b: Due knbped: R A+ Home Services 1 6/25/2002 Twirl. to mpSO 9: C"" kV blllbov.Gmw TANK GPM R R SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Uft Holding ut�IrJPrwale r"""�atOMi' �eT From Tank Field Station Tank s.wwru w Aneh Tank 1000G" W" 64.7 90.2 25 FIBERGLASS Nuw *!Dwrpw"""" 2 S„d a. W, 100+ 100+ LIFT STATION Lw Lk* 23 8 c MWKO . G" FouWkan 21.2 42 T.p owl a 11w OR lvNa Ho e.ler.Iwm R' 1 In ti b c.Dnk 1 100+ 1 100+ °'NMMake sMas" E `"P" PMwm.dby R"wd3 1 New Tank Only. 2 ExIst'g Tank was limed & BENCH MARK crushed In place. 3) The Tank moved 2.3' closer to the Lacaon wsn Dew+paon: Front steps well due to topographic restraints. The move does not A.wwnd El.e.Enn 100.0 FL adversly affect the performance or quality of the well. Engineer's Stamp OF ` Inspections performed by: Pannone Eng. SVC Dates: 1"6/25/2002 i ` 49— 0� 2nd06/25/2002 Department of Health a d Human Services approval T �'} ' """"""""i � iSleven H. Pannone.,t�` i ��J}' Reviewed and approved by: Date: rr l o y No. Ci 8149 rGc•W` •O� �j"iii RRe �Z..�.• 44 sass ,�� PERMIT NO, SVO20137 RECORD DRAWING I I I I I Y /SJR •WELL WASTEWATER ABSORPTION SYSTEM LOT IA1 LOFTY HEIGHTS S/D CLASS C Upper Huf f mark Road 49TM Lit Steven Pannone! No. CE 8149 ,,ft pm - P.I.D. NOt 017-411-34 \.._..------------ - ---1 P. EXIST'GEL WL _ _'_ /�y ! "`ANEW 1000 SEPTIC T NK / + I I + I I I � TI 21.2 38.0 1 EXIST'G T2 26.9 390 CI 28.9 39.7 ;%WFLL C2 29.8 39.9 I .DWG I DESIGN 2 BEDROOM HOUSE 100% SEPTIC TANK REQUIRED TANK REPLACEMENT ONLY PREPARED FORS Ms. Vicki Blodgett 8500 Upper HuFfnan Road Anchorage, Ak 99516 (907) 345-7144 NEW LOO 86.4 T SEPTIC TANK 86.2 PANNONE ENG. SVC,LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 Phone & Fax DATEi 9-15-02I RECORD SCALF, V-50' MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: May 31, 2002 Expiration Date: May 31, 2003 Permit Number: SW020137 Parcel ID: 017-411-34 Legal Description: LOFTY HEIGHTS LT 1A1 Design Engineer: 0062 Pannone Engineering Services Site Address: Owner Name: Ms. Vicki Blodgett Lot Size: 54264 SO. FT. Owner Address: 8500 UPPER HUFFMAN RD Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516-2521 This permit is for the construction of., ❑ Disposal Field [?] Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. + THE SEPTIC TANK USED TO REPLACE THE EXISTING FAILING TANK WILL BE NONMETALIC. L Received By: Issued By: � Date: &4 Date: Municipality of Anchorage C Development Services Department Building Safety Division _ On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017411.34 Permit Number SWOZO/37 Property owner(s) Ms. Vicki Blodgett Day phone 345.7144 Mailing address (1) 8500 Upper Huffman Road Mailing address (2) Anchorage, AK Zip Code 99516 Legal description (Lot, Block & Sub'd.) Lot 1A1 Lofty Heiqhts Legal description (Section, Township & Range) Lot Size 42457. AcreNumber of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 'rAN1�Qt Pclut�„�� THIS PROPERTY CONTAINS: o NG7 Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: " 7� / Date of Payment: �/Z �zz/ O Z Receipt Number. (90,34;_'69 (Rev. 12/00) c u Waiver Fees: "_6O0 J Date of Payment: 5/Z 49102 GJ Receipt Number. ,)03 q4r I�� o�QtJf S' s � Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907) 272-8218 (907) 272-8218 Fax May 27, 2002 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot IAl Lofty Heights Septic Tank Replacement Permit - Emergency Replacement Request Tank to Well Waiver Gentlemen: My firm was contacted in regards to a collapsed septic tank at the above referenced lot. The owner has indicated the tank is completely collapsed and sewage is backing up into the house. There is an emanate health threat. Issaacs Pumping is currently pumping the tank on a daily basis to prevent back up of sewage into the house. I am writing to request an immediate issuance of a septic tank replacement permit for this lot. I have attached a site plan showing where the proposed replacement tank will be located. I am also writing to request a separation distance waiver between the existing well and the proposed septic tank on the above referenced lot. 1 will address the waiver in its own section. Tank Replacement The lot is approximately 1.25acres in size. Lot lAl slopes to the west-northwest at approximately 3 to 5 percent in the area of the septic system. The slope is considerable steeper south and east of the system. The proposed installation will be located in the western portion of the lot. The existing tank is located approximately 61 feet from the well serving this lot and will be abandoned in place. The proposed septic tank will be installed approximately 67 feet from the existing well serving this lot and outside the well radius of Lot 1, Block 2 Woolever S/D. The proposed location is greater than 25 feet from the water service lines. The other surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. Waiver Request The well on lot IA was drilled on 5-10-84. The well log is available for this lot and is attached. I found that it is cased to over 40 feet, the static water level was 20 feet below ground level when I conducted a HAA investigation on June 30, 1997, and the total depth is 107 feet. The ground water in this area typically flows from the east to the west. The septic tank is located west of the well and approximately 20 feet lower than the well. A well flow test showed the static water lowered sixteen (16) feet while flowing at approximately 2.1 G.P.M. Water samples were taken during the IiAA investigation and indicate that there is no bacteria and 5.7 mg/1 of nitrates present in the water from this well. The septic tank in its current location is approximately 95 Mr. Jim Cross, P.E. May 27, 2002 Page 2 feet from the well on Lot 1, Block 2 Woolever S/D. The proposed location of the replacement tank would be outside that 100 foot well radius, thus eliminating the need for a waiver. The soils on the adjacent lot (Lot 7C, Ginami Hills S/D) were logged to be sandy clay with 30% gravel to a depth of 18 feet below ground, with wet sand and clay to a depth of 37 feet. Bedrock underlay the wet sand & clay to a depth of 205 feet. The well log is attached. As outlined under 18 AAC 80.020 and 18 AAC 72.021(a), I have calculated the following points: Distance from sewer system bottom to groundwater 4.5 Soil sorption below sewage system 2.5 Soil permeability below the system 2.0 Water table gradient 6.5 Horizontal separation 2_0 Total Points 16.5 16-25 Almost sure to be free from any form of contamination from household sewage. In my opinion, this waiver request meets the above criteria for approval and does not constitute risk to health. Additionally, this replacement will improve the situation in this area by relocating a tank outside a well radius and moving it farther from a well. I hope the above information will assist you in determining that the waiver should be granted. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, • [even R. Pannone, P.E. 49TH Attachments: ."_ PERMIT NO, SV02 1 I I I I / Y DESIGN WASTEWATER ABSORPTION SYSTEM LOT IAl LOFTY HEIGHTS S/D ' j CLASS C ✓ fWELL Upper Huf f ria WELL I I I I I 1 EXIST'G TANK,C❑LLA 1 I I Q � � P.I.D. NO, 017-411-34 _--\-•-------------\ - ---1 '... F-- - 20] til Dsm- i DESIGN 2 BEDROOM HOUSE 10008 SEPTIC TANK REQUIRED TANK REPLACEMENT ONLY PREPARED FOR: Ms. Vlckl Blodgett 8500 Upper Huffman Road Anchorage, Ak 99516 (907) 345-7144 EXIST'G WELL ----- 1000g ,SEPTIC TANK 3% 5 15% �Al Z-ROUSEi -- I I I I I 1 I i I I �1 £1 I win I I I = I CD I of i 1 le I I I t W 1+1 XIw V I X 1 I \� I Iv I 1 I I I l - I I NEW IOOOg SEPTIC TANK PANN❑NE ENG. SVC,LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 Phone & Fax DATE: 5-27-02I DESIGN SCAT F, V-50' . 1^+l'.`. �."..!!'.!1T74:�R1✓A^, 1rn'.!rMin!v;•y �T•T.T71Y�7jy�!'Ryy1C3„Cy..... ��•y...'.fn.....TT.:,IYwYM'JHM�..r.-... �,....•.,�.r'f'!.'I...-{�T'�._1 pr•r'� �:rq,>T". .'.�.. WATER WELL -RECORD..'...: ,-.. ^ - . STATE Or ALASKA '• �" r' 4' '• DEPARTMENT OF NATURAL RESpll1t4fi '•g Division of G4olo01Gof fl GfoPhZbhopalEurvrTa • •• �� LOCATION OF WELL '. l/bolo oo.►lele either Is. le ar 66.1 ofilllasnr.11 Ne. A.D.L. Ni. IA I YIp n H9 SeroeehLot (Nock - I 1 1/44118. I Soc Neo Me. Township N Ol Neap &[3 Meridiem 14 d ar_er_et� [O r0 . 013TANCE AMD DIN T If ROA/O IYTERSECTIONs Do [.OWNER OF WELL: ' erA0a18P: 4✓11��aA•-•tlt�� Street Address ale Aroe of Well Location [. WELL LOO not Seto• • iYHaeo Material Tree d. WELL DE/TM, (final( .L.LL—L1f. $: OAT! OF COMPLETION Too Bello. Q ..IC��'� ^f/. •. C1 Coble NM Dietary 13Dr1Yam 13OYo . .��- .y. / +�� ❑AYoo. ❑J.IIN Q[woe 13 other r' . 7. USE: ErCo.oetle O Pdblle Soppy ❑ ladwdry 0 Irritation 0bckpp 0Ce..erteel 4 �m O Tool We11 0 Other: S. [AiIMGt (] ThseeAd`F�r•IeN� �.y. D o b Wdrhl la . iris / M_ ft. Oeplh sticeev et. F✓'M ^"'�^�' �S s. FINISH OF WELL: /I Tye.: ! ��+r/ Olonelen tD ' ilallMoelcet Lonolh: ' ' set hotwosa 11. and ft. Sochfliline Sre.el reek 10. STATIC WATER LEVEL' L1 it. O Abova or @*looww land se�—rface S�e mJIJ/GirAtrry OI IJ.KNO➢ACCf E4YIP.eet food: DEPT. CF FEALTN 6 n ENVIZCNMENTAb PROIECIIE�NW II, PUMPING LEVEL below lead serto" and YIELD ' 11. off" All PWmpao "114-m- ;NoV 677UJ —ft. aRo,—Ism PUMPNI I.P.M. I. C 1 No . RI. C I. I Y Material: 0 NoatrG.mioml 0 Olhcr: is. PUMP, 111 available) NP p P Logia of Drop Plpo ft. egacllY 1►•w. w ' r ' Q sob.. O tot Q Coetrificel Q other w I4•111EMARRS: _ is. WATER WELL CONTRACTOR'S CERTIFICATION: Ia. Wolof Tewprelore [3 F O C This well use 4,111@4 or w rl•d1c1 n and this report is Ir.• b b. Nu of r •nem ale fad b•0./; L, �?,`dt.. jay �',�y a •JU/T I's Su m Ne. Const'"l pL]jc•asa Nuber r Address: / •/\ O J fi �LT•6sr� %?'L! -c,( !I A'- SIt»d: /i..�•c/ /. //.�4;V,f Deb: Aflher »d Rb(r••eareH.a "�'+." ^ .,.. , ,� � �..• `.i ;'LT�lC!FPAIT! Vr :::'I,a.rae 33ox 1303e •STAn adtp><.mic A SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 200 FnQt._ DRILLED AT THE RATE OF j18.00 PER FOOT. PROPERTY OWNER Mr. R1]•1 :.LOCATION OF.WELL SITE k. Sabo ' VLI__'Jfi tv1, (1�•� �� DRILLER _ Cl:berUU am of Rampart Drilling Works. � DL WELL'LOG: b;-;.480'8andy clay with 30% gravel. Several cobbles. 18�37!iiit I1inA at 18 feet. Clay with 15% gravel to 37 feet. Bedrock. A sedimentary rook. u -- >;'13}i58! GrmLUr rook shoring signs of water. Wet. Quart per minute. 15 170' 8edisentary rook. 1 •per' o'w i ick producing sore water. A possible 1 GPM total accumulation to 'this point. '174196• Sedisintary rook. ;,,196-198' A porous rook shoring more good aims of water. 1%iicating 100 improvement !ui yield. Total yield should show a possible TWO GPM. 5 C VZ, F{C.nD GV- W 1� .198..20$1 Sedimentary rook. Total footage: 203 feet. tri. riq :.,2 tl' oust to Mr. Em of 180 feets 43&0.00 Drilling Cost. I i . COST. INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF $3240.00 THANK YOU VERY MUCH. HIT CLAUS OF RAMPART DRILLING WORKS „bA-rr J=4 6th.77 :' ,[,I'.6EhVIci CHAROE0F ILO% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING & WATER MOMT WATER WELL RECORD LOCATION OF WELL BOROUON / ¢t18DIV] ION. I LOT I BLOCK SECTION OTRe - SECTION TOWNRIOP RANOE MERIDIAN 13N 0E , r 13S 13W LOCATION/SKETCH; WELL OWNEM DEPTHS MEASURED FROM:L]eesing top aground surface WELL DEPTH: DATE OF COMPLETION Depth of holo: .wi it BOREHOLE DATA: Depth Depth of cesing:.P. y it Material Type and Calor From To O �} DEPTFj,TO STATIC WATER LEVELt /L res.. �.`_ft below X19 torp of casing ❑ ground surface neR�V :ep.A' r, .�•f/I t ! Date: _i.._l1.ytPJ1 •" y METHOD OF DRILLING: X air rotary ❑ cable tool • E% �� 0 other - (r USE OF WELL: $.domestic O Irrigation ❑ monitor a public supply a other CASINO STICK•UPt •► , tt. Diem: In. to_ft Casing type:_Z) z !.l' —In. to �1t RECEIVED JAN 31'�9�t°9 r JvIun clpaln of Anchorage Dept. Health & Hunan SerViaoe CONTRACTOR INFORMATION: Registered Gusiness Name bigneture of Authorized Respteeentative WELL INTAKE OPENING TYPEf a open end ❑ screened ❑ perforated Qopen holo Depths Of openings: to ft SCREEN TYPE: Diam: in. Slot/Mesh Size: Length: 11 GRAVEL PACK TYPE: _ Volume usod:. Depth to top: GROUT TYPE; •:..f ,A,* Volume: Depth: from j,3 Ittttot'�� It DEVELOPMENT METHOD: Duration " . P MPING LEVEL A7%.'A IE D: d it after hrs pumpingppm PUMP INTAKE DEPTH: It Horsepower: WELL DISINFECTED UPON COMPLETION? 0 YES O NO REMARKS: i ato ' .r PLEASE MAIL WHITE COPY OF LOG TO: DNR/DIVISION OF MINING & WATER MOMT PO BOX 107005 ANCHORAGE AK 99670.7009 R 141 Municipality of Anchorage George P. Il'uerch, Mayor or /�J Bttikiing Safety Div7sim P.O. Box 196650. 4700 S. Bragate Sheet Anchorage, Alaska 99519.6650 a (907) 343.5301 h ttp://eittiv.ci.anchomgc.ak.us 5/31/2002 Steven Pannone, PE Pannone Engineering Services, LLC P.O. Box 102954 Anchorage, Alaska 99510-2954 Subject: Waiver Request for Lofty Heights Lot IAl Waiver Request 4WR020018 Parcel ID 4017-411-34 Construction Permit Number SW020137 Dear Mr. Pannone: Department of Public Works Your request for a waiver of the required 100 feet horizontal separation from the septic tank to private well has been approved. The approved separation distance is 67.0 feet. This approval is conditional upon the use of a septic tank made of any material other than steel. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, �/a / Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program c Municipality of Anchorage Development Services Department � Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519.6650 www.ci.anchorage.ak.us (907)343.7904 Mi WI:W. Date Received: 06128102 Waiver Review Worksheet PID#: 017.411-34 HAM Legal Description: Lofty Hefahts Lot 1All Engineer. Pannone Enofneerina Services. LLC Steven R. Pannone. PE Applicant: Ms, Vicki Bfodaett 67 Waiver Requested: Afi feet from seotic tank to well Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation inn Permits: SWOZO137 Points: Waiver is Granted: X Waiver is not Granted: List Conditions or Reasons for above: SVE A ff4rNS h Date: S /31 /0 2 By: 194AI Name of Reviewer ................................................................... .mess......$ Rec#: 20328 Amount: $800.00 Date Paid: 612812002 WA/vER REQuE5T FOR LOFTY HF16N7-S Lor /A/ IvAIvER Af4ttEsr NuNORt wROZO0/8 WAIVER /'tEQpES r Foot WELL TO SEPIIc rook OF IrV . —SfPric TiAIR— Tf/F SEPTIC MAIX Ex 11TI'& IS IN p 1r1lTE OF FA/[G/ 0(COLAp3Ed). THE tWW EX/sr/Nb SEs°rfc rrINK /5 Q _ fTE�ELe T/gNK N/rf EyIfTaO W W W no°o IAS I rs cujfRENT La6/fr-,aA/ S/.vCE /%r%/. Tale MN/C /r ^� 4gWT/rF Su0.TaCr WELL R.v4 TKE t---FLLvm Lor I VAk 2 WdoeE�ER oHa oa inn suoo Is 9S'/rw►+y. Tl/t EN(r/uEER M4 -f i/t000se17 TI CONtrAueT A NOW SEOtiC r7 AA( • n wrojr Our OF PTs rlc. To AVa/n C o RR OJ/oA1 ANO PL/9 CE /T 6 7 FIxOn i7jF. Viv—LoT WSLL *AO 1001i- PAPP T/ -/E �L /6KBaRiti6. T-Uf Ti�NK /f L acArE0 Odwwv C-xovtFA-,Z- 'ft FKoM TME wrli. I,v opgasr/o,v ON 2rolo SLOPE, TYE 1-I0Aty /S COUTth 19RrIrEEN \, THE WELL IN (?U&Si /aN : rlYE 10ROOPSE.0 SrPrIC r.#NK LOE�T/OA! —WELL 0,4M— ria wF-LL IN QNEST/av is /07' PEER % e er; ITf w/4rElQ iRarl /q- FRACraRE /}T' /O3iEEr, TwE S/'gric L-Arelf LEvF-L_ /s •¢T 16 FEET. BED R dCI< IA., rH/S WELL /S EA C acNr4r9ra +T ¢ / FEET. rkF- S e I!. if PAF- GKAvGL :%*AO wlrA, A He -,My 511_7- IN /r, j1(/f SO/L I t 7YP/C/fLLT' vr)¢ Y &C,0,0 ArrX E'ATk&,c-T OF fIEIOr/C T/9"tiK /EFfLuE'NT. Tf{E 060ROLK A010EARf ra H,4✓E' I4 DRYER ny�},V 25% SLOrE acv /r RS =r P/4SfEs me* WELL /aol- ro T/l� S E/r/� %CNK. r/{E fE✓ric >��-+t /s rhtso toC.rrXO AV Efr' OFTNE t, F-L-1-to0"EsWou PK]T/.V& Ir HY)PAI ULICOU)" Va-M GRAPIR , FKom rkE HELL. I I S, of A• 0. E. C. S. D. W C. R. 0. LVOTER TAOLE f / ' •= 8 rANK vErnl 33' «�� SOIL SOR9TfON W W I ;;; 7 -NE Son. V ET1vEEN 600WVD f uleFMCC BEDfYOCk 9r DESCRIPE0 AS )i SArvDY C t A Y Wrrk 30 %. 6rt*VEL� ptjeCOLArroty )2*,rF .�.. ►O K.o /i�". AAA nnr PE MM4011 17'// r 143 R4o✓F _wArs* r,401.E JrP*Vl6w7- ASIKKC coN1sjtv&r,v6 /0%0 /�ORiZONrpL 11:PA•RMTION 67' x 12 (rR 14P turn/- CONCLuflo✓ (,►Qfq.vr wvvex poiNTs 4.3 2.0 6.0 1.3- 14.8 .s GF'' --VER ANCHORAGE AREA BORO}JA,3H HEALTH DEPARTMENT i NO 794 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM .c 77- NAME-C��«` ��%�� ADDRESS �;� '`t -Z PHONE LOCATION LEGAL DESCRIPTION `Q� /f%�D4l1 /�Tf • Sl/�' SEPTIC TANK: r� DISTANCE FROM WELL -MATERIAL NUMBER OF s��/� COMPARTMENTS LIQUID LIQUID CAPACITY /2/1 GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS -OUTSIDE DIAMETER OR WIDTH / LENGTHaeXZ9, DEPTH , LINING MATERIAIf// U� ��/� -�X�� / DISTANCE FROM WELL �S / BUILDING FOUNDATION -24 / NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: Al/'q TOTAL LENGTH DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTIO AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELLP'el��T� �,�ou Gsi�l�� ✓� f0� DISTANCE FROM i WATER TYPEG-66� -0 DEPTH%/%.WX•z6;o BUILDING FOUNDATION. /4 SAMPLE NEAREST i NEAREST . SEPTIC / SEEPAGE OTHER LOT LINE /(� SEWER LINE Z f , TANK SYSTEM _5`-L CESSPOOL ��, SOURCES ��'l DIAGRAM OF SYSTEM DISTANCES: DATE ��i�� APPROVED GAAB-HD2 GREATEN ANCHORAGE AREA 'OROUGH Case No. HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT f t ��i T -'f'v /t`•/ � � LJ .S NAME OF APPLICANT'��' /' � �'� (f� f>.: ,,,. MAILING ADDRESS, PHONE NO RESIDENCE ADDRESS LOCATION OF INSTALLATION ��ocw_ fid` LEGAL DESCRIPTION •A" APPLICATION TO INSTALL: SEPTIC TANK_— , SEEPAGE PIT— , DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY `�j �.Lcle'.+1 e—!� F' e c✓roo'-f S FINANCED THROUGHTO BE INSTALLED BY / 0 t• �(L PERCOLATION TEST RESULTS 1 �3 r ANTICIPATED DATE OF COMPLETION 7" ILL BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS M4 �, 4 Z PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED r� SEPTIC TANK SIZE loo(' TYPE 20 e ¢ SEEPAGE AREA ----TYPE niAr,RAM OF SYSTEM DISTANCES: / HEALTH AVTHO R ITV OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28 68 and that the above described system is in accordance with said code. __ i r 0 r 41-7 i ovpi WANTS SIGNATURE r IW^ Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcell.D. O1 1. GENERAL INFORMATI^"t Complete legal descripti Location (site address) Expiration Date: Current Property owner(s) Mailing address Real Estate Agent 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: %I Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone P TYPE OF WASTEWATER DISPOSAL: Individual %I Holding Tank ❑ Community ❑ Public Sewer ❑ WaiverNariance request for: I7 d AIA dre c q rc_ Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 7 Zb ('.77 - �y � O Waiver Fee $ Date of Payment 7( lq �k 6� 1� Date of Payment Receipt Number Receipt Number COSA-#- 05(_14153�~ 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 sr in effect at the time of installation. Name of Firm r'CVc tn� � N c F A C �r Phone—_Z 7 -7 (% Address C1 P WC e Engineer's Printed Name Jev SOrr W,E; Date tea, By Original Certificate Date: The Mt clr o An orage 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 blue sheet f < t DSD SIGNATURE % * - ` 9T ki ;r i� �..`�.` e System #1 Approved for bedrooms <.. s System #2 Approved for bedrooms g MICHAEL" CE A6 GC kSCiF �g?°'�vf,!!•'<�°° Disapproved `� "' SFr?o5(Sa; Conditional approval for i,° bedrooms, with the following stipulatlTJh�A�> By Original Certificate Date: The Mt clr o An orage 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 blue sheet f < 4_ If more than 1 septic system is on the tot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: L O�N i�Frtsh �� l v'E % �F / Parcel ID: (>l-cl//� 3�{ A. WELL DATA Well type Vf% v a If A, B, or C provide PWSID # Well Log (YIN) Date completed 5 t0 Sanitary seal (Y/N)Wires properly protected (Y/N)_ Total depth /D ft. Cased to �Y7/ft, Casing height (above ground) `iD . in. FROM WELL LOG AT INSPECTION Date of test Static water level --Ll ft. Well production /r g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate i "Sq mg/L Arsenic —�— ug/L Date of sample: ( 'L / y Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material rq'!F(u S S Date installed Tank size i v o a gal. Number of Compartments Cleanouts (Y/N) y I'mindatinn Cleanout (Y!N) Depression^tan!` /l`i,(Y 4;...vat.r;,I . w I,,) Date of pumping Pumper ArV4A 2 c(oe%, C. ABSORPTION FIELD DATA Date installed 71(19-71 Soil rating (g.p.d./ft2 ft2/ dr !K '} System type Z U Length 2-�( ft. Width ft. Gravel below pipe (r" fE i Total depth _/01�ft. Eff. abs rption-area y 2-4 fe Monitoring tube Y Depression over field Date of adequacy test ai t Results (Pass/Fail) p� 5 For bedrooms Fluid depth in absorption field before test Z1 f , in. Water added 4 T/ tgal. New depth in. q Elapsed Time: 11 -HP min. Final fluid depth ` XY in. Absorption rate >_ `Yt) g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) _ If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES WELL ON LOTTO: Size in gallons level at Cycles tested I t Septic tanWlift station on lot -(0417 r Absorption field on lot Public sewer main Sewer /septic service line 't70 Animal containment areas l fs i � SEPTICIHOLDING TANK ON LOT TO: Manhole/Access (Y)N) _ in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots I Od t fi On adjacent lots / ti U t -E-- Public sewer manhole%ieanout r Holding tank (d� Manure/animal excrete storage areas 10,9 r Building foundation "Z It L Property line -.?- 3 Absorption field--2--(- water ield'Z—fWater main N Water service line % O e Surface water /00 f- Wells on adjacent lots 100 tk ABSORPTION FIELD ON LOT TO: �� r r Property line Building foundation V_ Water main.�r Water Service line 0 Surface water t&0(4' Driveway, parking/vehicle storage Curtain drain 14- Wells on adjacent lots (00Y - F. COMMENTS /1y 6\h IU M dh G. ENGINEER'S CERTIFICATION 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. Engineer's Printed Name JJ((AC2,y � 4tpr� ' • Date /C/'/ I Li COSA brown sheet_10-10-12.doc F. A(��9� 1p� vH 4'r1'4 � 0- MICHAEL N. ANCERSC4•: CE 9 A lOieoroESQ:y`v'� .J 4 \ Municipality of Anchorage + 1 Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street s- P.O. Box 196650 Anchorage, AK 99519-6650 3 •„� www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-411-34 COSA# 0� Mari” Expiration Date: 6;—al- b 1. GENERAL INFORMATION Complete legal description Lot 1 A-1 Lofty Heights Location (site address) 8500 Upper Huffman .24/4/-3c: Current Property owner(s) Vickie Prewitt Day phone 3,(5-7144 Mailing address 8500 Upper Huffman Road, Anch AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site 19 Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 3-16-07 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water OF A:•levels that may fluctuate during the year, and the water usage of the family being served by the system : `p1.•"•"'•"fj 71,ese conditions are outside the control of the evaluator of this system All systems eventually fail and �'Jf/• ''�y�1# satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future-•-----+•--� performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed 00- Steve. ronnoni above. Any reliance upon or use of this report by any other person or party is not authorized nor will it�i:% No 49, G: confer any legal right whatsoever. 5. DSD SIGNATURE �Oa,�sta�;•`� Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory _� Other By: a � Original Certificate Date: Ing.,. „Ast Municipality of Anchorage Development Services Department Building Safety Division On-SSe Water & Wastewater Program 4700 Bragaw Street P.O. Box 19665D Anchorage, AK 99519.665D www.muni.orglonslte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A. WELL DATA Well We Private Date completed 5/10/1989 if A, B, or C provide PWSID # Sanitary seal (Y/N) Yom} Total depth 107 ft. Cased to ,S2_ft. FROM WELL LOG Data of test 5/10/1989 Static water level /8 ft. Well production 1.8 g.p.m. WATER SAMPLE RESULTS: Coliform -j�colonies/100 mL Nitrate -5-43- mglL Well Log (Y/N) Wires properly protected (YIN) Yes Casing height (above ground) 2.5 in. AT INSPECTION 35 ft. 2.1 g.p.m. Other bacteria -&— colonies/100 mL Arsenic:: `i lj� ugA Date of sample: 3/6/2007 Collected by: Iff B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Fiberglass Date Installed 6/25/2002 Tank aim 1000_ gal. Number of Compartments 2 Cleanouts (YIN) Yes Foundation cleanout (YIN) YM Depression over tank (Y/N) PJQ High water alarm (Y/N) No Date of pumping 3/7/2007 Pumper A+ Home Serivices C. ABSORPTION FIELD DATA Date installed 7/19/1971 Soil rating (g.p.d./fe or ft2/bdrm)143 System type -Cd¢ Length 24 ft. Width 19 ft. Gravel below pipe 6 ft. Total depth #A ft. Eft. absorption area 42¢_W Monitoring tuba )�n Depression over field NQ Date of adequacy test 3/6/2007 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 23 in. Water added45O gal. New depth3_iQ in. Elapsed Time: 1440 min. Final fluid depth 29 in. Absorption rate >- 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed `Pump on" level at _ in. Datum Size in gallons N/A Manhole/Access (Y/N) _ "Pump off" level at _ in. High water alarm level at Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtft station on lot 64.7 Absorption field on lot 90.2 " Public sewer main N/A Sewer /septic service line 30 Animal containment areas 100+ Meats alar 8 circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/deanout NIA Holding tank 100+ Manurelanimal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 21.2 Property line _�J Absorption field 21 Water main 100+ Water service line 60 Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 0 • Building foundation 80 Water main 80+ Water Service line 90 Surface water 100+ Driveway, parkingivehicle storage 50+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS • - Waivers on File G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspedlons and review of Municipal records that the above systems are in conformance with MOA COSA guidelines In effect on this date. Engineer's Printed Name Steven It. Pannone. P.E. Data 3/16/2007 COSA Fee $ 3y Ru t- 1S Waiver Fee $ _ Date of Payment 3-/6-()7 De fe of Payment Receipt Number 30 (o Receipt Number (Rev. 11/05) I' In. Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 070062 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot IAl of Lofty Heights subdivision. This inspection revealed a nitrate concentration of 5.33 milligrams per liter (mg/L) was reported for the property's well water sample. 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. Municipality of Anchorage Affidavit of Owner -Occupancy for Accessory Dwelling Units I, I 'c/,. /��o c/oe �I �r��/ = cver the age of 18 yew's, aad ma.Ue the statements herein of actual knowledge. 1. The legal description of my property is /--7/ 7A also known as zma.v_/ PLAT ,6ri-IZD (street address), and there is an existing or proposed accessory dwelling unit (ADU) at this address. 2. I understand that in order to maintain an ADU in the Municipality of Anchorage, the property owner must reside in either the principal dwelling unit or the ADU for more than six months of each year. In other words, the property must be owner -occupied, per Section 21.45.035 of the Anchorage Municipal Code. 3. I own this property, and this property is my legal residence for more than six months of each year. 4. At no time will more than two people reside in the ADU. 5. I understand that the ADU permit is not transferable and will notify prospective purchasers of the limitations of the Municipality of Anchorage's ADU regulations. 6. I will notify the Municipal Zoning Code Compliance Division if the ADU is modified from the plans approved by the Building Safety Division, or if the ADU is removed from this property. 7. I understand that the Municipality may subject me to a civil penalty per AMC 14.60.030 and/or require'the rern6val of the ADU if any of the regdirements at AMC 21.45.035 are violated. 8. I aeree that this document will be recorded as a deed restriction with the Anchorage Recording District I declare under penalty SIGNED: that the foregoing is true and correct. PRINTED NAME: ri--4 ^1'o,1re 7/ fiP�yi/ DATE: l/y�o 77 On this B�dav of %I <«X , 20 o7, before me the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and swom, personally appeared before me and to me know to be the individual described in and executed the foregoing instrument, and acknowledged that he or she signed the same as his or her free and voluntary act and deed, for the uses and purposes therein mentioned. ' GIVEN under my hand and official seal this,day of /� o'er ti , 20u? NOTARY PUBLIC in and ..,rL,o SM -Le oft,.mn.a i�gPUBLICP \ My commission expires Anchorage Recording District Return ori_anal recorded document to: MOA/Planning Department PO Box 196650 Anchorage, AK 99519-6650 PC—=t# 00-0e841 LOT 7C — � 10' lJT1LfTY EASEMENT — _ N 89'58'G01N 164.80' HUFFMAN T o-. x.,2.,' sHED,. 8 20' UTILITY EAS EN ROAD WOOL.EVER SUBO I CONCRETE WALKWAY DiIJFW[IIT�� GINpMI HILLS SUBO. I LOT 7D %_ CANT -ENCLOSED IS X 4.0' HUFFMAN ROAD :D 4AI"AY rf I RM LOT 1 I I I N I Z $ 8.0' X 10.0' GREENHOUSE I g I 10' UTILITY EASEMENTS _/' N LOT 1 A-1 N 54,264 s.f. I �, I LOT 2A NI I� 10 I I I I LOT 2 I 1 I 1 I NOTE: DUE TOSNO I VERAGE I I I I UMRWOFOPAVING IS APPROXIMATE I ..L — — — — — S 89'580440E 164.77' SUB 0 LOT 1 HILL Tt7ILSOM6 PLOT PLAN _ AS BUILT X SCALE JL- 40' GRID2N-Z84 1 Project No. 07-013 Lang & Associates, inc. 1ISM Daryl Avenue, Anchorage, Alaska 99515-3049 907 522-8476 Phone Registered Land Surveyors 907; 522-4625 Fax kglangisOalaska.nef / 1ciangle0alaska.net 1 hereby certify that 1 have surveyed the following described property: A\Q ' % P- LOT 1A-1, LOFTY HEIGHTS SUBDIVISION ((PLAT No. 89-120);' 4923 v 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 promises and }hof then are no roadways, transmission lines or other visible 'rL ' KENNETH C. easements on sold property except as Indicated hereon. Dated this the 22'- Day of E= etY , 2doj, at Anchorage, Alaska l M Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not 000ear on the recorded subdivtetnn stn+. 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` 1 2 Parcel I.D. # b ( *1j q) ` '- "q HAA # 1. GENERAL INFORMATION Complete legal description L) �► f L��,��— �/0 1 Location,(site address ordirections) lxacx lila lr1C�l1� Property owner—0Q.bns Yl Day phon[� Mailing address NAVffijck_ AAC:�Y . �' 1 � L L Lending agency Day phone Mailing `a lddress Agenty �� B oDay phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: \3 �° 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site_ 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. 1/9/) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firmpk'o/')O�"a 6?Nk. Svc Phone Address P ©• Lo`F i u zo 2s SAN �l� A �� s/Lr-zo �s Engineer's signature Date�lQ 49th�� 6. DHHS SIGNATURE aq�oS X Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. performed to insure the wells continued suitability. Current nitrate concentration s 5.74 m C' . More information on nitrates is available from the On-site Services Program, DHHS, Additional Comments r� .. - r-77 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. Municipality of Anchorage "' El V' DEPARTMENT OF HEALTH & HUMAN SERVICESL - M� Environmental Services Division JUL 61997Cjhh5 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907W;�-, a7�1�of Anchorage Dept. Health & Human Services /. ¢ /Health Authority Approval Checklist Legal Description: 40- j� f �� /1/ '16 413'ercel I.D.: o!' 7 F_11Rh944g97-11%Ve1 Well type f VCt i If A, B, or C, attach ADEC letter. ADEC water system number Log present ON) Date completed '5-hOl'Tep Total depth Cased to Sanitary seal (Y/N) FROM WELL LOG Date of test R Static water level 10 Well production I's WATER SAMPLE RESULTS: Coliform I0 .� I Casing height (above ground) 2 - s Wires properly protected (Y/N) AT INSPECTION GIso f9 7 g.p.m. { g.p.m. Nitrate 5,7A Other bacteria Date of sample: _LII � �% Collected by: / F/e'/,-5-ha A- e r - B. SEPTIC/HOLDING TANK DATA � C' Date installed �'I f y % j? -1 Tank size 1 &o rp Number of Compartments I Cleanouts (Y/N) `t' Foundation cleanout (Y/N) `( Depression (Y/N) Al High water alarm (Y/N) 98 4 f mom e 5cw, _ Date of Pumping Pumper C. ABSORPTION FIELD DATA Date installed `��r4 1'7-1. Soil rating (g.p.d./ft2 or ft2/bdrm) /u3 System type GO a C RIR Length Z q Width 17 Gravel thickness below pipe 6 Total depth tie 6 Effective absorption area Lf2 & Monitoring Tube present (Y/N) Depression over field (YIN) yt"'_ Date of adequacy test 61319 7 4 , Results (Pass/Fail) T} rA S C . For 3 bedrooms r Fluid depth in absorption field before test (in.); Z3 `' Immediately aftergSDgal. water added (in.): 0-8v Fluid depth 23 n (ins) Minutes later: Zu 6�Absorption rate = 4-5-0 g.p.d. Peroxide treatment (past 12 months) (Y/N) YV (2 If yes, give date 7- 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES u SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons "Pump off" level at" i Septic/holding tank on lot On adjacent lots t �o Absorption field on lot Rz, 4 WAtV&-Y 4-rrA tJ4 UO On adjacent lots < Do Public sewer main Al A Public sewer manhole/cleanout N Sewer /septic service line 30, Lift station ^/ 1A loo `s" SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TOS:. p t Foundation Property line Absorption field r Water main/service line ScJ ` Surface water/drainage Tont Wells on adjacent lots `apt w A�� c A-rtat[(Im SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: CoA to wL A -c -cd N&0 t -- Property line 10, Building foundation Fd Water main/service line t5d Surface water e 00�k- Curtain drain /cno't- F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area 1004 - Wells on adjacent lots I (2'O I certify that I have determined thru field inspections and review of Municipal records in conformance with MOA HAA guidelines in effect on this date. {M Ale QQ }} Signature.:�6� g Engineer's Name G t`TZtc3• Date :F r s - HAA Fee $ ��C_Q , [ ;C i Waiver Fee $ Date of Payment 1 --V Receipt Number L -x C)a"\ (A 72-026 (Rev. 3/96)' Date of Payment Receipt Number Moven R. f'dpnOflQ ,F - $149 0 a, r.rr144 are I Lor I, acK z, �,o WOOLEUEA 5�0 I I I II LOT 2, Qt k 2 �uooLEvcA ��D cc i I LH[O�%t f MOOrr + T CE. 7509 r t• r.� 4444 LoT f.4, GOFTY Ne/G'HTS SIC) S ITE PAA-( i DA re.: prvN 8 Y: TFn II Norg: 'rM,; is Mor A fetRvEj,io rtAr Aft LOr ArfOlVf ARE ,4PIAeXlNAYR' CrY 7 I rt I Lor I, acK z, �,o WOOLEUEA 5�0 I I I II LOT 2, Qt k 2 �uooLEvcA ��D cc i I LH[O�%t f MOOrr + T CE. 7509 r t• r.� 4444 LoT f.4, GOFTY Ne/G'HTS SIC) S ITE PAA-( i DA re.: prvN 8 Y: TFn II Norg: 'rM,; is Mor A fetRvEj,io rtAr Aft LOr ArfOlVf ARE ,4PIAeXlNAYR' Municipality of Anchorage ' Department of Health and Human Services 625 "L" Street Tom Fink. P.O. Box 196650 Anchorage, Alaska 995%-6650 Meyw 343-4744 August 1, 1988 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: waiver Request for Lot lA Lofty Heights Subdivision Waiver Request iwR88-026, A88-0219 Dear Mr. Moore: Your request :^r waiver of the required 100 foct separation of a septic system t� a private well has been approved. The approved separation di..tance is 95 feet. Ninety feet (90'1 from septic system zo 4:he well on Lot 1 Block 2 Woolever Subdivision. approvalThis s ero fact from the seepagepit nonuthe subject alot idistanceon z to the west lot line. This waiver approval plies to the existing septic system to well separation only. Any future upgrade to either w: .1 applies require all separation distances be met or another approval from this department. Sincee�rellyy,, �""�`�' Daniel J. Roth Civil Engineer On-site Services DJR/ljwi6 frtr. MUNICIPALITY OF ANCHORAGE, ' DEPARTMENT OF HEALTH & HUMAN SERVICES �} Division of Environmental Services CM, WN On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 7— L4, 11— 24 HAA# ;.`)y.1` .2L S,' -!f: 1. GENERAL INFORMATION Complete legal description Location (site address or directions) & �l' U n o e ✓""O� Property owner C rc�c ° R -co ulYl Day phone a2 q 3— D 3 Co �(' �O leo � n �S-_�' 2.76 -►2/3— ��SB Mailing address , Lending agency Cl- L dor Day phone Mailing Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 N 3. TYPE OF WATER SUPPLY: Individual well '/ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ll/ 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.l/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Phone 0-711 % Name of Firm ��nn n � -z 1 ✓ / ! .'-5- Address Engineer's signature 6. 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: Date t '/I l 4 Z- bedrooms, with the following stipulations: Date 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 921 Mun1icipality of Anchorage Department of Health & Human Services A HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: G -WA LjU t P-ejj--� S Parcel I.D. 61 7'� 1411' A. WELL DATA Well type F�_ If A, B, or C, attach ADEC letter. ADEC water system numper Log present (Y/N) Date completed f%eYaya � Driller 44p,'we-- - J9• o o+�:q� µ Total depth 1 n Cased to L/Z t Casing height y Sanitary seal (Y/N) Wires properly protected (Y/N) tiJ FROM WELL LOG AT INSPECTION 1E - Date test �7//L) Date of °2 3 �� Static water level �� Well flow b g.p.m. g.p.m. U' B6 �`•-vim' Pump level 2�'e rM SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 4� ; On adjacent lots �a J Absorption field on lot ` b �,J ; On adjacent lots Public sewer main N/ Public sewer manhole/cleanout Sewer service line ! Petroleum tank M),(// op6-7" %/ af�%s WATER SAMPLE RESULTS: Coliform 0 / Nitrate 3.1 Other bacteria `9 Date of sample: I /nd' 'Z Collected by: .5- B. SEPTIC/HOLDING TANK DATA Date installed -71R! 71 Tank size Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) N/A Alarm tested (Y/N) Jg1A Date of pumping '"�1 L 6 r Z Pumper �Q ►ila` / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: �/ o,�tx,t/- t Ss V We] I(s)onlot Onadjacentlots Io� SlopT�JFoundation 37 To property line > A�bsorption field 32-- Water main/service line %J� D Surface water/drainage ' ` 0 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATIONt Date installed Size in gallons Vent (Y/N) High water alarm level — "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested Surface water _ Date installed '7//1/7 / Soil rating N3 System type 46 Lrr b Length Width Gravel thickness (O Total depth f5• D Total absorption area (0 Cleanouts present (Y/N) Y_ - Depression over field (Y/N) Date of adequacy test Results (pass/fail) for bedrooms Peroxide treatment (Past 12 months) (Y/N) NA_ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: k��r Well on lot �_O._ -J - On adjacent lots g �-� Property line S °"� To building foundation �� To existing or abandoned system on lot On adjacent lots > bAO Cutbank 30 ';�o' �! Water main/service line > U Surface water �f ` Driveway, parking/vehicle storage area U Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signature v Engineer's Name �-t S '_ �A=lA k a Date 1, 2–, HAAFee $ 170 - Date 70< Date of Payment Receipt Number �y l �' C � ? /y oa nna io..., vn•i o..,.� unn o� Waiver Fee: $ Date of Payment Receipt Number r MUNICIPALITY OF ANCHORAGE�� • Department of Health & Human Services M DIVISION OF ENVIRONMENTAL SERVICES M}t 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # t 1 - ) 1 HAA # (\ S'kl LA ZO 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) aso0 uyl�er' �frIFC -f l3f (b) Property owner CAucbr 1`fcur din Telephone: (home) 31,5 -307s'Business 2GS-2SYr Mailing Address FSS Go G(nper f�uman /dam (c) Lending Institution AkAho t ll /3417k c -*(afk" Telephone Mailing Address 13epco,7 c/- /'1cn1?Gr0y4a branch - pit,ele Ccrru..4cl (d) Real Estate Company and Agent Le fl /Au /39 / Fy - Tea) Address 6060 O' nal(e c{ Anch A¢ r 99Si� Telephone 3Y6 - 3 o3s (e) Mail the HAA to the following address: (or check here B, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family 19 3. WATER SUPPLY Teo-( ticoa Number of bedrooms 3 Individual Well 63 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site 10 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legaiity and status. 72-025 (Rev. 7/88) Page 1 of 2 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 (= /a ifv.p 7'cr6/1 i« 1 Servci<r Telephone 3 yr- r ass Address 1 `7'530 /=cA. Sl„ Anc,hor'ar�11 /996- /� Date OGf 2o, 196 Ar y '1T1I •.....................�... 4 �- �gineer's Seal �'::........... •. THEODORE F. ,'ACORE •• I� CE - 3539% v; 6. DHHS APPROVAL Approved for _ - 3 bedrooms by j/ -� Date Approved Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 notconduct 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. 7/88) Back Page 2 of 2 00 'exd� OF A. WELL DATA Well Classification r« MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 Mi 343-4744 Legal Description: 1-0f 1 AL o��v f% If A, B, C, D.E.C. Approved (Y/N) NA Well Log Present (Y/N) Y Date Completed Deed enea i'10/69 Yield161/re/89 °t'i Total Depth 10 Z_ Cased to Sectr&ck Depth of Grouting N, 4. Static Water Level 17' Pump Set At > 10 3 Casing Height Above Ground 2 ` Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) i Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 62 c . b. On Adjoining Lots > 1 U0 To Nearest Edge of Absorption Field on Lot 95,` R-er ar-44tlf ; On Adjoining Lots > 100 To Nearest Public Sewer Line All A. To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot > 2s IF Water Sample Collected by 7- F rrao. e ; Date t0 ALA. Water Sample Test Results Sccksf-uc%ry a cn,6_orr, Zi0om4 2, S- 71-O niffafe — A/ Comments Wa.1ver rssu.e-C 8/f /88 {or Sena�chv� bc><wce� 4 -c -el( and so Pr_ 5vs!-rte t B. SEPTIC/HOLDING TANK DATA Date Installed 7/19/7/ SizeG�No. of Compartments Standpipes (Y/N) Depression over Tank (Y/N) Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) i Date Last Pumped 10/26652 S v A- f Pumping/Maintenance Contact on File (Y/N) for Holding Tank High -Water Alarm (Y/N) N. A. Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 6 Z' 4�rorn. c •o. To Building Foundation To Property Line x 30 ` To Disposal Field To Water Main/Service Line 3-7' 3z All To Stream, Pond, Lake or Major Drainage Course > !aa Comments Senara'ACIA c4aliznce 16 7%ix c. eff /tcia/ crf /-+n o insfu//«frees 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 11Y3 0' /6drm Type of System Design Seep eXe P')' Date Installed 7 / OF ( 7 / Length of Field 2,Y I Width of Field f 9 1 Depth of Field Gravel Bed Thickness Square Feet of Absortion Area 11' Standpipes Present (Y/N) E r, Depression over Field (Y/N) 1V Date of Last Adequacy Test 16/ 16/ &9 Results of Last Adequacy Test AGfegctct -e �ar 3 be4roa Mv SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well9_ 3— 1aer as- yu' f f To Property Line o To Building Foundation ? To Existing or Abandoned System on Lot Al, 4. ; On Adjoining Lots > 30 To Water Main/Service Line 7 2s To Cutback (if present) '20 Z' cufhan �- To Stream, Pond, Lake, or Major Drainage Course > Iva' To Driveway, Parking Area, or Vehicle Storage Area .To Comments Seoarahan /a /? ce ujawery t-crk ( e / 1 /8' D. LIFT STATION 61 . Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidJo r,�kVffect on the date of this �inspection. � (}�• �� ©� Signed � Company Tec%n'r Date ©cf 20 1989 •••,•°••.......� `�ngineer'sSeal 0 MOA No. 8 i O.S 2 jT,...••.°°°.a ••.... •fit . Ti•IEODORE F. :1008E • � CF - 3589 •' �' Receipt No. Receipt No. Date of Payment 1 /—.2 —o Amount: $ Z%G'- 0 D Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 Ti „ WATER WELL RECORD rt - - STATE OF ALASKA DEPARTMENT OF NATURAL RES jtg$ Division of Geological 8 Geophys >aI Surveys T v Drilling Permit No. LOCATION OF WELL (P/aou complete either la, Ib o. Ic.) A.D.L. No.' fr lo. Borough94; Block /Lot l Ibjj 1/e at re. _ of_ of—of —. le.11 DISTANCE AND FDIR TFON F OM ROAD INTERSECTIONS f't Street Address and Area of Well Location Section No. Township NO Range EO Meridian 30 WO 3. OWNER OF WELL:/ : J Address: 2. WELL LOG - Feet Below - 4. WELL DEPTH: (final) S. DATE OF COMPLETION Surface sp Material Type Top Bottom ,/Otz ft. < — ../V — i __ 6. 0 Cable tool C3eitotory .[] Driven 0 Dug OAuger OJetted OBored []Other: T.USE: Domestic O Public Supply O Industry E] Irrigation Recharge 0 Commerical n C] Test Well Other: r - B. CASING: Threaded `j7�}�Welded �4 diam. in. to }t. Depth Weight Ib ft. diom. In. to ft. Depth Stickup ft. 9. FINISH OF WELL: TYpe: %' = --F Diameter: b SIot/Mesh/Size: Length: Set between ft. and ft. Backfilling Gravel pack 10. STATIC WATER LEVEL: _ ri ft. 1 � E] Above or E]Below land surface e Equipment used: / DEPT. OF EACH & ENVRONMENTAI PROTEMCIV I I . PUMPING LEVEL below land surface and YIELD�y ft. after hrs. pumping 1. 1f 9 -p.m. 0 4=1711 ft. offer hrs. pumping S. p.m. 12.GROUTING Well Grouted: E] Yes E] No - Material: E] Neat Cement [] Othir: 13. PUMP: If available) HP ut Length of Drop Pipe ft. capacity p.p.m. y r O Subm. E] Jet Csntrifical E] Other e 0 14. REMARKS: z 0 16. WATER WELL CONTRACTORS CERTIFICATION: I15. Water Temperature _o O F O C This wall was drilled P er m rj�risdictl n and this report is true to the best of my kno I dge and belief; e tered a as$ Nam Contract }L/csnssee Number Address: - 0 A0 1-/ Date: / D of R04iesentative MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL��' Qa OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date MaY a- /988 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) A, Hor><r /�e;o-hfr SID Location (address or directions) SS -00 cuter R—< - (b) Property Owner cAgr(& Marian Telephone: Home :NS' -307 Business 26S -21'y/ Mailing Address 6. '00 user A6 i as Rte., AACAOnjx e 4k- 995-/C' (c) Lending Institution ki. A I Telephone Mailing Address (d) Real Estate Company and Agent unt ue Reat -Tenn I'crun.m Address 6660 O' f-wlev Rot Andwn7e Ak 99.5-V t Telephone 3 tib ^ 3b (e) Mail the HAA to the followina address: or: Check here ®, if hold for pick up. List contact person and day phone number below. '%'CQC 1'bor e- 3 YS- 13 ss 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well ® Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ® Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 tRev 8/861 Front 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 js in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. MvFl Walutr neeo°e-o' well -sewa9.e`„f scjoezrokd� Name of Firm_Fa610�' lec"i'l' Telephone 3`/S- /�5S Address _!y53U Ec�ia S� At, ctioragQ J}G� 99-16' Date htay 'a n �'�',. ��•,� SA co 44 .•0 - THEODORE R. MOORS �• i% . CE - 3589 2 ) $ inee 's Seal,. •• V4a�� 4%fpr®� �O 4i0o 6. DHHS APPROVAL � bedrooms ate �— 2 �8 Approved for by Approved X Disapproved Terms of Conditional Approval Conditional 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 (Rev 8/86) Back M!JNICIEALITY OF ANCHORAGE RMYIRONMENTAL SERVICES DIVISION JUN 9 1988 RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description:��f / % �` H014417, Well Classification rrtvatt If A, B, C, D.E.C. Approved (Y/N) N. /1-, Well Log Present (Y/N) ly Date Completed 147 O Yield 3 jy am rAemr S-10498 Total Depth h`6 Cased toDepth of Grouting R'4 Static Water Level t2F' Pump Set At NS Casing Height Above Ground 27 it Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 62 10 C. C'. ; On Adjoining Lots > coo To Nearest Edge of Absorption Field on Lot f o Y' -,4v CO. • On Adjoining Lots YS' Perat_b_Vf To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole N, 4. To Nearest Sewer Service Line on Lot Water Sample Collected by T r, /'700r,t Water Sample Test Results ; Date Comments jE Mealr<rcol- d�•f� of we l/ % 62 '16 ' c (&"' /r,�, o� m✓inq o s //sla& ylarver ne ec,,a zGr wet(— e4r sCectrcl{4on — see (eff-f- B. SEPTIC/HOLDING TANK DATA Date Installed '7112 r 7 / Size1000 e7a I No. of Compartments f Standpipes (Y/N) 'K Air -tight Caps (Y/N) 4' Foundation Cleanout (Y/N) f' Depression over Tank (Y/N) N Date Last Pumped ;/71 If& yy Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) ;for A k. Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 6Z' '40,.+ C' 0, To Building Foundation To Property Line To Water Main/Service Line Course `7 (0C) N,A- 3;1( To Disposal Field 3 2 r To Stream, Pond, Lake, or Major Drainage Comments n1eIh bar's We'd 102' i5 (one d1(AancP) - drop s est t J)See tuac��r Page 1 of 2 72-026 (Rev. 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata f'0 a' //3d,-,�, Type of System Design See e e P/i Date Installed Width of Field Length of Field e Y Depth of Field �+ Gravel Bed Thickness Square Feet of Absorption Area Y 2l Standpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test y- 16 /61F Results of Last Adequacy Test Adeo?uaFP 3 bedroomr Separation Distance from Absorption Field: To Water -Supply Well 9 f- ' ee r ar-AN+IF To Property Line I{r c" f e"/F To Building Foundation 73 1To Existing or Abandoned System on Lot On Adjoining Lots 7 361 ' To Water Main/Service Line To Cutbank (if present) _20 2' c �iha�f To Stream/Pond/Lake/or Major Drainage Course > (UO To Driveway, Parking Area, or Vehicle Storage Area too Comments (//a(ver n.eeoeea< :P2 r- we//— seed« .e t�t SVcrr�kao y See (e4e,- D. LIFT STATION 1\1' Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) 'Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify thaatt�I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company E(�* �ec�i S�� MOA No. a8 -C-r Receipt No. .10V I Date of Payment L Amount: $ (� 5?D Page 2 of 2 72-026 (Rev 81861 Back 1ryS3: aa''i cl Y:i r ,fngineer's Seal 73;•x. TflG, °<a°ea ooe at (�°° 0°°0000°00°Ofq 0°1 0 yy �Lo �5 �, °°^THEODORE MOORc 7 +, �:?, `q C.: i= • 3';89 �' % „ Municipality of Anchorage Department of Health and Human Services dhh5 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 1, 1988 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot lA Lofty Heights Subdivision Waiver Request #WR88-026, H88-0219 Dear Mr. Moore: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 95 feet. Ninety feet (90') from septic system to the well on Lot .1 Block 2 Woolever Subdivision. This approval also includes the separation distance of zero feet from the seepage pit on the subject lot to the west lot line. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, ,6_2-A� �- Daniel J. Roth Civil Engineer On-site Services DJR/ljw#6 Municipality of Anchorage Department of Health and Human Services dhh5 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 August 1, 1988 Gary A. Capps 12500 Toilsome Hill Drive Anchorage, Alaska 99516-3352 Subject: Septic Tank on Lot lA Lofty Heights subd. Being Encroached Upon by the Well on Lot 1 Blk 2 Woolever Subdivision Dear Mr. Capps: It has recently been brought to my attention during the Health Authority Approval process for your neighbor's lot, Lot lA Lofty Heights Subdivision, that your well is located 90 feet from his septic tank. The required separation distance as stated in Title 15.65, Municipality of Anchorage Wastewater Disposal Regulations, Section 15.65.040, (I.1), is 100 feet. Your neighbor cannot receive a full approval of his septic system from the department until this matter is resolved. Because the date of your neighbors septic system construction is July 19, 1971, and your well was constructed at a later date, the responsibility of correcting this matter would be yours. The two options available for you to correct this matter are: (1) You may hire an approved engineer to perform a waiver study on the 90 foot separation to determine the possible impact on the well water and submit it to the department for approval, or (2) you may apply for a permit from the department to abandon the old well and drill a new one to meet the required 100 foot separation distance to the -septic tank on Lot 1A. You must bring your well into compliance by August 31, 1988 or the department may take legal action to have this matter resolved. If this deadline is unreasonable or you have any questions regarding the above you can contact me at 343-4744. Sincerely, ;�_9 Daniel J. Roth` Civil Engineer On -Site Services cc: Al Sundquist, P.E., Manager On -Site Services/Water Quality Programs CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 May 26, 1988 ANCHORAGE, ALASKA 99516 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIOPi M.O.A. Dept. of Health and Human Services SUN g 1988 P.O. Box 6-650 Anchorage, AK 99502 RECEIVED RE: Waiver for well -absorption field separation, Lot I A, Lofty Heights S/D Dear Sirs: By means of this letter I am requesting a waiver down t 95 f t from the required 100 fo separation distance between the well and the sest part of the seepage pit o Lot 1 A f Lofty Heights S/D. The wnicta hould also recognize that there is only a 9 + foottion between th on this lot an the w on_Lot ock2, of Woolever S/D Copies of pertinent backup documentation as well as adequacy test ata and a site plan are enclosed. Although no driller's log is available, other records indicate that the well was drilled in 1970. On May 18 of this year I measured the total depth of the well to be 46 feet below the top of the casing. Part of this depth is probably in bedrock. The static water level stood at 18 feet below the top of the casing. I determined the total yield of the well by running the pump to draw the water level down to the pump intake in the vicinity of 46 feet over several cycles, and then measured the recovery rate to be 1.3 gpm. This exceeds the minimum requirement for a 3 bedroom residence. I could hear no cascading water or other indication of a perforated casing. Water samples taken that day were satisfactory, showing 0 coliform colonies per 100 ml, and 2.6 mg/1 of Nitrate -N. The wastewater disposal system consists of a 1000 gallon, single compartment, steel septic tank located 55 feet from the well, which is followed by a 24' by 19' by 6' deep seepage pit, the closest portion of which is 95 feet from the well, according to the as -built. The cleanout pipe is actually 104 feet from the well. No waiver should be required for the septic tank separation, because it was installed at the time when the required distance was only 50 feet. At the start of my adequacy test the fluid depth in the seepage pit was 41 inches. By adding measured quantities of water in 50 to 75 gallon doses while monitoring the rise and subsequent fall of the fluid level in the pit, I determined that the pit does continue to absorb at an adequate rate for a three bedroom residence. The topography of the lot slopes steeply at about 30% from the southeast down to the northwest, with the house and wellhead constructed on one terrace, and the septic system standpipes situated on another terrace approximately 6 feet lower. Thus, in the event the seepage pit were to fail resulting in the surfacing of effluent, there is no possibility this effluent could flow towards the well head. The soil log prepared at the time of construction of the seepage pit shows a mixture of GM and GW soils with an average soil rating of 143 square feet per bedroom for the stratum in which the pit is constructed. The soils below 9 feet are shown as GW. The soil log for Lot 1, Block 2, of Woolever S/D, located immediately to the west, shows poor to well graded sand between 5 and 8 feet, with gravelly, silty sand beneath to at least 16 feet, with a soil rating of 203 square feet per bedroom. No water table was reported on either of these logs. The soils shown on both logs should provide good treatment of the effluent. The 41 inch static fluid depth in the seepage pit indicates that the soils are in fact tight enough to permit the buildup of a clogging mat at the soil interface, which helps ensure full secondary treatment. Every indication is that the underlying bedrock (and water table, if any) slopes parallel to the surface topography, which is perpendicular to the direction from the seepage pit to the well. While the 2.6 mg/l nitrate -N is higher than the level found many places in Anchorage, it is well below the State standard of 10 mg/1, and is also significantly lower than many other nitrate levels which have been recently measured in the immediate area. Thus, there is no indication of contamination reaching this well. Based on the above rationale, it is my opinion that the requested waiver can be granted without endangering public health, and should be granted. The well on Lot 1, Block 2, Woolever S/D was installed in 1974, shortly after the required separation distance between well and septic tank was increased from 50 feet to 100 feet. I measured the slope distance between that well and the septic standpipe to be 102 feet, and estimated the drop to the well to be 25 feet, yielding a horizontal separation distance between the tank and well of a little over 90 feet. Since the presence of that well has no effect on the operation of the septic system on Lot 1 A, Lofty Heights, and since the well was installed by the owner of the adjoining lot at a later date, it is my opinion that no waiver of this separation distance is actually required for Health Authority Approval of Lot 1 A, Lofty Heights, whereas one would be required for HAA of the adjoining lot. Sincerely, riho�— Ted Moore, P.E. CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. June 21, 1988 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 M.O.A. Dept. of Health and Human Services P.O. Bog 196650 Anchorage, AK 99519 Attn: Dan Roth Dear Mr. Roth: By means of this letter I wish to amend my waiver request dated May 26 for Lot I A, Lofty Heights S/D to include a lot line waiver to allow the existing seepage pit to remain within 0 feet of the west property line. The as -built drawing prepared at the time of the pit's construction in 1971 shows the edge of the pit to be contiguous with the lot line. It is my opinion that the presence of the pit in this location poses no additional constraints on the future use of the adjoining parcel (Lot 1, Block 2, Woolever S/D), as it is approximately 10 feet from a house on that lot, with that house's septic system being located on the other, downhill, side. Please give me a call if you have any questions. Sincerely, Ted Moore, A.E. wr41CIPA-1 OFEA HNORpGE DEPT' OF H PROTECTION ENVIRONMENTAL �� 2.11968 10 t __- ffGuSE aT B L fz 2, ao0 wootEvl:fi s/o oc.o. Lo'T 2./ Bek 2 GWooG.0 tvc-fi -31L w *co 4 —* �.. .... THEODORE F. MOOR[ ; ?. CE - 3589 yam® BGS%(Jr •'•..,a,<'''•(`��.ii 1— 1 9 u.Ef. L. moo, oT !A� / OFTY Hr�/Gy Ts S /Q S lTE PG.A N NorE: Tff/S rS /PoT A S•c nvovbD PG -AT p1-( I-OC47-101es 41?C- A-PPROXfM,4TE FLATTOP TECHNICAL SERVICES 14530 Echo St., Anchorage, AK 99516 Ph. (907) 345-1355 ADEQUACY TEST DATA SHEET Legal Description: of Street Address: SSoo Gc��, Human Rd Client Name: rAackc Marsh Test Date: S/!8/8B Tested By:_ •TF lYoore Initial Conditions: Float #1in_See��rc Rfco, set B9" b.t.o. 27" Float #2 in�&�-9 �co set 9a " b.t.o, y2 " Float #3 in set " b.t.o.. " Float #4 in set " b.t.o. " Water added through: pipe w. f/ " fluid pipe w. 63 " fluid pipe.w. " fluid pipe w. " fluid ACTION TAKEN TIME H2O METER NET. GAL WELL LEVEL See e S_ ePh� Tnk if S{u t l: is /06558 O /g' y/ O k : 2y /OA6 C/ G3 'l / nraabl e 2'!Y S�o Pue,� 0 eS S/op Ret%arf ! ; 2 7 1:32 f : 3S' 1 : y0 2:07 ?:12 2: !6 2. 2p 8:$-z k OS 63 $ lab 67 3 /08633 IOeGG� 1 oB 6T9 2 1019 69le 7S 159 yS yS H 7s, 27 07 2S g 1 2 Y2 VV/ --F?-71e` Y/'6 Y �B t yig Y O 1 /2 r'9 y S 09 3:17 s/ vs '/y Vy 3.-- d o K: /0, yf >l MP aIO io> 109 t y�zo Sams, i'leasureu Well Yield S4j?af c /,3q/gym Ade quate for 3 Bdrms Unit Absorption Capacity a 77y�! r�lE� Surge Capacityf&27a( ' Average Absorption Rate �7" w2 i/min V 3�m,n Adequate for 3 Bdrms REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) i.ame.of person requesting approval 2 • Ztalv�- of property- owner LA)Q 3 • ••gel_ desr_ript i -on 4. Numbcr'cf.)>edrooms in house 5. Water.Analygis: a. hacterl.dl b. Detergent 6, W7 11 data: a. yj,,z bltlQC� b . Deptt, c. Casing Size P d. Distance from well to closest existing or proposed: 1. Sewer line 2. Septic tank ` b 3. Seepage Area tot r 4. Cesspool' 5. Property Line 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. 7. Sewage disposal system. a. Age of system i b. Septic tank capacity in gallons c. Name of septic tank manufacturer 1. If "home made" show diagram on reverse side of this form. d; Disposal field or seepage pit size and type 1. Distance to property. line to house foundation p f' %- e, Percolation Test `resuLt5 f, Percolation Test performed by `°- Use the reverse.side of this form to show diagram. Diagram should include the fol -lowing, information: property lines; -well location, house location, noir_ tank location, disposal area location, location of percolation test, aL,-i direction of ground slope. 9. The s-,r•t;nn this form is true and correct to the best of my knowledge. Signature of Applicant Date Signed TO BE FILL -ED -00T BY HEALTH DEPARTMENT PERSONNEL LD t,e above described sanitary facilities are hereby approved, subject to the owing conditions: Conditions. The above described sanitary facilities are disapproved for the following reasons: Signature of afflel,;"' ------ Approval is valid for one year following the date of approval. CPJ:cw C—)—;- / C !T. WON Tanker MITAT: Sauer and Ator lymwn For lot 1, 14114t, AWKWO-In wie 7as insoncrion of the sobject projerty (;n p, ON :102 mob; 1A w constructed to rect Rcmou-� , COMM get a water S!Mqjv because the w3ter won not it is r Opirinn that thr, wator spiply muld Q ytabio. mmor ;;stun p1mently Consinty Or a •c n,; Am Am riot mct Armyl: SWUytdar,,'-s lw-,x vc-rc i��, roo- to inutall au ap;roved ycwor systv, tv revi Amoco ro- .41 Fi-;r the sever systrm could he Own penjinn to U1, flumis to colkar UIC costs UF installation, A Im2yu 1)" CjjFI'jT i4 jQ1149, Y,K. javinistraLive Arvctm' IRPY'I 14 October 1116 Plauning Dopermont Anchorogo, AIM*' z3i3 4wL S q. Lofty fitaLLY+a 2, vax6y SWIVIS100 Caw - 3. sponflovb View valthts War pro. Hobaboverg Vo ha Nv roviawed thy jubpot plata lop neweraze digponal and wavor supply I'E.i: f+ibility our C!#-�v1 iY=`!�'P,i are Aa !P`!'+.lds�i`wnt A Public f4�uvv and vatur Wa .4IWatn .are not a+tatlabiq tea 0% 10a3t.ion. The lots are sized adequately tell Por acv Sita sewage dispoop l aW .a r #�up .�, j n F$�£'�k"�.8' ® 10 all an .�a�1��7R"��',tO.'�i4$.Y'i L;.£3Sa��+a��2i '. 00" i:g>N& "ar tables or topayrap& at this AMR% P0110 a0va e disponox ON vAtor tupply WHASU are aaVAUA air to a+�+e�..�rwew*�wH•.Y �.nw+�w�.•wsvw+xw..».e.m+xwwa+a�..rt+.m».+�++i�zt=r tya-%.n.IS .YO~ W 7tiai`or L'f;H"aMOS fi3rc not O.`#lSKa'xWto US location& .�.+.W It dinougai g davolvIrAnt €! the %p Qr 09HU12 Y arms" with local :10" tbrough Oho QRO of Oar 5 ito UOWO Snd vOtOr >< stv"30 la araas vebero 06 QUIP WOr eyailablo in vrom small WOW Croated oy 4ndnlyinr, AM, which Qro reoNrynd frou lowalixed AM= 'Idopl3gov wQ wondur what "1111 happon whou amptin Wk MUM " add4j to vona bw-Ahv,;, it WOU14 SOON ImponsIblo to uvoid W411 COA- tomMation a; ounao focal,atur. -w W! that Wa* thispe. ewnu,14 be diacuszo A WIM the geological P*UP!4 y4w vikthar tha" wuiving for their atudy to bu c04QI0tQd* hinearoly 0 DIVID R. L. BUNCAN9 4,50 �taical air4ctor Qjhv� 9AO*t � 4u(. As W.+%SO, A(J JivAvlr n�1 I II- n111I11H„n �� ECONOMIC DEVELOPMENT AND PLANNING P.O. Box 196650 OFFICE USE Anchorage, Alaska 99519-6650 PRELIMINARY PLAT APPLICATION RECD 13Y: VERIFY OWN: A. Please fill in the information' L requested below. Print one letter or number per block Do not write in the shaded blockly7 -- •r, 1. Vacation Code 2. Tax Iden tj�iGafig(V o. 3. NEIN abbreviated legal description (T12N• R2W SEC 2 LOT 45 OR-SP49T 9tY9 BLrlrls LOT4*). it 4. EXISTING abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34) full legal on back page. 5. Petitioner's Name (Last - First) MR811 ■ 10018©■Q■■■■ ■■■■■■■■■■■■■■■■■■■■ Address SSOO LW?37- WrUFFMAN V_t> City State th-r Phone# 345-3015 Zip gRsl to f) 1 `7 t / 12”- 1 6. Petitioner's Representative maeoeee�m�oeoe■■�■�■■�■■ logo Address 1-131 C-.EnF_Cnn 15CL.L C ITZC U6' city A14C A<);w-,5 State AK ggsis Phone# Zip 31SIS 7. Petition Area 8. Proposed 9. Existing 10. Grid Number 11. Zone Acreage Number Number Lots Lots 11Z 5 poi o0 2841 �'9 12 Fee $ 3 ! C% ` CT& 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 subdivide it in conformance with Chapter 21 of the Anchorage Municipal Code of Ordinances. I understand that payment of the basic subdivision fee is nonrefundable and is to cover the costs associated with processing this application, that it does not assure approval of the subdivision. I also understand that additional fees may be assessed if the Municipality's costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff, Platting Board, Planning Commission, or the Assembly due to administrative reasons. Date: —/!o )Ey m4t,61 Signature S R R A j �n P r Q in nn *Agents must provide written proof or authorization. C. Please check or fill in the following: 1. Comprehensive Plan — Land Use Classification Residential Commercial Parks/Open Space Transportation Related 2. Comprehensive Plan — Land Use Intensity Special Study 3. Environmental Factors (if any): a. Wetland 1. Developable 2. Conservation 3. Preservation Marginal Land Commercial/Industrial Public Lands/Institutions Dwelling Units per Acre Alpine/Slope Affected b. Avalanche c. Floodplain Alpine/Slope Affected Industrial Special Study 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. SouTw 55' of RuFFMAw QAnp AozA",' q 'TD L.oT Lk,, LOFT`t 64mlenRT5 SUR. F. Checklist Waiver 30 Copies of Plat V ✓ Reduced Copy of Plat (81/2 x 11) L Certificate to Plat Fee /Topo Map 3 Copies ✓Soils Report 4 Copies 6jV -)ZAerial Photo Housing Stock Map LZoning Map Water: Private Wells Community Well Public Utility '/ Sewer: Private Septic Community Sys. Public Utility VACATION OF RIGHT-OF-WAY OR OFFICE USE • EASEMENT APPLICATIONj� Municfpalify of Anchorage RECD BY: ,. DEPARTMENT OF COMMUNITY PLANNING - vERiFy,oww A P.O. Box 6650 '168_ Anchorage, Alaska 99502-085(3-`x' A. Please fill in the.I below. Print one letter or number per block. Do not write in the shadedvocks.� 0. Case Number.(JB 1.. Vacation EV#1E%. PLANNING ZONING OCT 2 Abbreviated Description of Vacation (EAST 200 FEET SOME ST ET) 3. Existing abbreviated legal- description, (Ti 2N R2W SEC 2 LOT 45 OR SHORT SUB' BLK 3 LOT 34). oeeeeo�eo�000a�Q�� omooeaoi��oe��■��■ Address —6500 uff�- RUFF?AP44 1ZT> Address 1131 InaeOKC,% Eta" GtzcLz City State AX- a4sl(o city A►,Lur�fZAXsla. State- ,aK— g4515 Phone No. 34!S-1015 Bill MeS— Phone No. 345 -64 -up Bill Me 6. Petition Area Acreage 7. Proposed Number 8. Existing Number • __9:_ Traffia.Analysis Zone .Lots D 0 1 Lots Liu EW 10. Grid Number 11. Zone 2841 W —9 J� r-� 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 costs to process this application exceed the basic fee. I further understand that assigned hearing dates are tentative and may have to be postponed by Planning Staff; Platting Board, Planning Commission, or the Assembly due to administrative reasons. Date: Signature 8 8 Q jr D r: C G 'Agents must provide written proof or authorization. C. Please check or fill in the following: 1. Comprehensiv*-A nd Use Classification,.. Parks/ iii Spate .- Transportation Related 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 Alpine/Slope Affected b. Avalanche c. Floodplain Alpine/Slope Affected Industrial Special Study d; Seismic Zone (Harding/Lawsohy- 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 Legal description for advertising. F. Checklist V 30 Copies of Plat Reduced Copy of Plat (81/2 x 11) Certificate taflat . Fee ' ✓ Topo Map 3 Copies Soils Report 4 Copies See- /3-1� ay°�°• ✓ Aerial Photo ✓ Housing Stock Map Zoning Map Water: Private Wells Sewer: ✓ Private Septic 20-019 eaCk (4185) Waiver Community Well Public Utility Community Sys. Public Utility