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HomeMy WebLinkAboutFYFE BLK G LT 3� � � \� : � � � : � \ .� > - � � :� °» : : - y e � « © © y � s - «� � � � t � g y > < ^ � / 2 + > — ^ + « . � » � � Z�\ ? : a � � a< - � \�� v > } ° \ > - - a « « - \ ± < « - c « � § « � ~^ - � . � } � � / APPLIC,` OJT FILLS OUT UPPER HAL% ONLY Prop -arty Owner .0( y j �/� ` i � QGf Phone '� 9 (�� G/� ` Nailing Address Zip Code Buyer �iG/��— d_� �. ���rs Gis. e{,%�/�^J?�2 AddressF Zip Code Lending Institution[ u ✓ �y , �� Phone Address Zip Code Realty Co. & Agent��' Pow / f� (a LI r,��. /i� Phone Address 6 �_�� O �� Zip Code Legal Description r- /O -^ r`" Street Location's Type of Residence Single Family Multiple Family No. of Bedrooms ❑ Other Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal-<� ❑ Individual Year Individual Installed: Public Utility When Connected to Public Utility: "7 ❑ Holding Tank — Z X-- 7S- _ / & S"j v -• NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. �n n Lr A nl fC44--1 Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspectors t{ o�aeA Field Notes: MUNICIPAWY OF ANCHORAGE ENVIRJ JP.'._f,:A_ ; ..o,EMION � f . J (�E P 1 RECEIVED () APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: v r Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72-023 (3182( G u Y GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 0(v� 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received cl� 12'1f Time of Inspection Date of Inspections J REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: �)Iq L��rn1 �� „t,,, ,o Phone: 2. Property Owner: o,-1 ro � �Jir � x �,Gr�, Phone: �'C��_ r �� Mailing Address:�(�, 3. Legal Description: Y f 4. Location: 5. Type of facility to be inspected ,� No. of bedrooms 6. Well Data: A. Type �_ a x _i L)r of i a B. Depth 15C� C. Construction D. Bacterial Analysis 7. Sewage Disposal System: A. Installed I r�,S B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line , Sewer Lines , EQ-034 (1/74) Page 1 of two pages •�t� M1CM1;"•4AOL f k' S, f GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality g�A,LtFO ,,e 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 J71UASb ,• REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV 2. Property Owner: Den LA , c X_ , S Mailing Address: 3-__ l.YzP Day Phone F,5;;'.2 3. Name of Buyer: rro„CL Mailing Address: o- [may Phone 4. Name of Lending Institution: Mailing Address: ��ss�ey S 3/9 1�� _� Phone _2 7�- coo i 5. Name of Realtor or Agent: S�/�PyU"--i!:�GI P Mailing Address: -ePhone o2 7 2 - S-7/ 6. Legal Description: o Location:, 7. Type of Facility to be inspected: No. Bdrms, sn 8. Water Supply Type of Supply: Public Utility Individual �- If Individual, number of dwellings presently served / If Individual, depth of well /J'_6 9. Sewage Disposal System Type.of System: Public Utility Individual (on -site) If Individual, date of installation / % %S' Z)/ J 1, 1 cf /f41 EQ-037 (1/74) Page 2 of two pages - Re 3t for Approval of Individual 2r & ,Water Facilities Legal Description Comments Approved Disapproved Date :�-_-y/c _-� (�" Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)