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HomeMy WebLinkAboutFYFE BLK G LT 38TE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON -SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ii "n C' Ja h a 1279 PHONE 7(0(0/1 ED NEW ;RUPGRADE MAILING ADDRESS ��tyq E• LEGAL DESCRIPTION of 35., LOCATION NO. OF BEDROOMS DISTANCE TO: Well ion area Dwelling PERMIT NO. 2 CL < W I.- Manufacturer ke, Material No. of compartments Cn Liq. capacity in gallons I F H 0 15*1 Inside Ie6tV'00 Width Liquid depth _j 0 z DISTANCE TO. Well PERMIT NO. 02 — < Manufacturer W: Material Liquid capacity in gallons O _j W DISTANCE TO: WellNo. &61�Peatiop Nearest lot line PERMIT NO. LLJ _j LL Z pc No. of lines Length of e lines (z 2 Trench width inches Distance between lines I— Top of tile to finish grade eneath tile inches Total effective absorption area Uj 0 Length Width Depth PERMIT NO. < W0. Type of crib Crib diameter Crib depth Total effective absorption area uj co DISTANCE TO: Well Building foundation Nearest lot line _j _j Class Depth Driller o I0 Distance tt line (D PERMIT NO. Lu DISTANCE TO: Building foundation i Sewer line > Septic tank lVorve Absorption area(s) OTHER ha" elz_ PIPE MATERIALS SO I L TEST RAT[ NG INSTALLER REMARKS WQA e4)U,,SeX 610,P-,.vr_AA. -C1-&eA lull QS Q_C%Sky"!' io (a16.1o__ k&' J6 Ck 4. =- " <�s > APPROVED DATE LEGAL /2-Ul 3 (Hev. 3/78) Time Time ie Date Date Date //�� ���__ �-t�/ � — Inspector Inspector Inspector Comments Conditional Approval IJ-SIFT OdCOOfiIS Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank wAPPLICANT FLLS OUT LOWED HALF ONLY Property Owner F �' �J Phone(' Mailing Address '�(� J C�,� p i Buyer -o m C'0 Address Lending Institution � v. '' � �' ` S� Phone Address 4 Realty Co. & Agent 'i F M i e f/1 6" lZs u( LT 7 tvo Phone Y Address Legal Description ti 3 Street Location Typ of Residence V Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Wat Supply r Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. Sewage Disposal Individual Year Individual Installed: f Public Utility When Connected to Public,l- ti ity- ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST I EFORE PROCESSING CAN BE INITIATED. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Lj)�f� /0.4 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION 1 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Charles J. Young MAILING ADDRESS 1707 East 58th Avenue 99502 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE Michael A. Virostko 752-2196/w MAILING ADDRESS 5308 Taku Drive #4 3. LENDING INSTITUTION PHONE Lomas and Nettleton Company 1274-7661 MAILING ADDRESS 4449 Business Park Boulevard 99503 4. REALTOR/AGENT PHONE Mary Jo Anthony 1276-1333 MAILING ADDRESS 207 East Northern Lights Boulevard, Suite 102 99503 5. LEGAL DESCRIPTION Lot 38 Block G Fyfe Subdivision STREET LOCATION 1707 East 58th Avenue 99502 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ?9' SINGLE FAMILY ❑ One ❑ Four ❑ Other XX Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY XKk INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date ???? If system is over two (2) years old an adequacy test is required �© PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. /L-u lino//6) 4 AUNICIPALITY OF ANCHORAGs_ Department of Health and Environmental Protection ® 825 L Street, Anchorage, Alaska 99501 264-4720 west for Approval of Individual Sewer and Water Facilities 1. Property Owner: Charles J. Young Mailing Address: 1707 E. 58th Ave., Anchorage, AK Phone: 2. 3. Name of Buyer: Mailing Address: Michael A. Virostko 5308 Taku Dr. #4, Anchorage, AK Phone: 752-2196-Offic( Lending Institution: The Lomas & Nettleton Company Mailing Address: 4449 Business Park Blvd., Anchor. AK Phone: 274-7661 4. Realtor/Agent: Mary Jo Anthony Mailing Address: 207 E. Northern Lights Blvd. Ste 102 5. ME Legal Description: Street Location: Lot 38, Block G. Fyfe S/D 1707 E. 58th Ave., Anchorage, AK Single Family Residence: Multiple Family Residence: (X) Number of Bedrooms: Phone: 276-1333 ( ) Number of Bedrooms: 9 7. Water Supply: *Individual Well ( ) Public/Community System ( ) If Individual Well, well depth X If Community System, name of system 8. Sewage Disposal System: *'On -site System ( ) Public System ( ) If On -site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. **If on -site sewer system is over two(2) years old an adequacy test is required by this department. MUNICIPALITY' OF ANCHORAGE TH A fee of $25.00 must accompany each requesvlg,LLing can be initiated. ial� r 4' 1 1978 3/77 0 COL-bu MUNICIPALI OF ANCH MUNICIPALITY OF ANCHORAGE DEPT. F HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT[O®NVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 19 ENVIRONMENTAL ENGINEERING DIVISION NOV 16 1978 0 Telephone 264-4720 -RECEIVED" REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES n DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER C�v.e �.� �• PHONE 3AQq 3 MAILING ADDRESS V-- PROPERTY RESIDENT (If different from above) PHONE Z�,_ 5 csc) 6 V 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION �\ � PHONE MAILING ADDRESS 4. REALTOR/A ENT PHONE MAILING ADDRESS` 5. LEGAL DESC!ZTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS 9? SINGLE FAMILY ❑ Four ❑ Other ❑,� 2---Two tlCf l wo ❑ Five ❑ ' MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY 2-- INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date PUBLIC UTILITY If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. / G -v IV to/ 1 0) a�'`�¢TfiCpOiaCE ��,F o 0 G 7 y N iaA � 1 GP,EATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received 7110 174 Time of Inspection t f. Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR kl, zq 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 4, Location: / 7 d7 5. Type of facility to be inspected 6. Well Data: Phone: .2 7 j- 3 5 3 6 ?- �C7%3a3 No. of bedrooms 1119-1 A. Type B. Depth . C. Construction D. Bacterial Analysis �7X 7. Sewage Disposal System: A. Installed 0 B. Installer 211 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 Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages yy NgCN04A0! A a b. y GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality �,npo 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 JA9u*4y . REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA k FHA CONV 2. Property Owner: Mailing Address: :� - ��Z� / Day Phone 0-/,,7 �� 6 3. Name of Buyer: Mailing Address: Day Phone 4. Name of Lending Institution: Mailing Address: Phone 5. Name of Realtor or Agent: Mailing Address: ` ��2z� � � [� �-b 4V �,L�P h o n e V- 7 7 6. Legal Description : a�-� '1�7Ll Location: `7 7. Type of Facility to be inspected: ���-� _ No. Bdrms. i 8. Water Supply Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type.of System: Public Utility Individual (on -site) If Individual, date of installation EQ-037 (1/74) Page 9- of two pages - Request for Approval of Individual S—,er & Water Facilities Legal Description Comments Approved �,.�vrr._ �'n��,«U Disapproved Date Sh Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM i a �t r 1 r I 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)