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APPLIC NT FILLS OUT UPPER HAI ONLY
Properly Owner ) U o i 1 f-( /`(
--f? I C- /- r
Address
./-A[Plone',
IMailing
Zip Code2U
Buyer
Time
Address /''0 !�-( l__
Zip Code
Lending Institution —� --., ,,,-�
one
Address--'�,''.>;
Zip Code
Date
Realty Co. & Agent
Date
Phone
Address ��--� C? k._J k_.
Zip Code
Legal Description
S
Street Location - -
�- - ------ -'_�-
1
Type of Residence
{ Single Family
J�
Inspector
❑ Multiple Family No. of Bedrooms
Inspector
❑ Other
Water Supply
11 Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Community
7/ n
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
Field Notes: - --1,-.=t
-'
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l
Sewer Disposal
Individual
Year Individual Installed:
Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION
FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Dale
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
f
.-.�
7/ n
Field Notes: - --1,-.=t
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( APPROVED BEDROOMS`{
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE 12 W "'-
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area /C1
Well Log Received
Well to Tank �".- ��
Septic Tank Size
do t -c -I/e_ (-tn
OL-ISSL 01 —
January 6, 1.1.11LS3
J m , R j. ( , 1-1
99 5 0 7
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itolo"", I-
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-110 f0l: MIC I-Ovinw�
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oll
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iloted
fizlvf-± hoop c c) r 1, ,
oc L.od thm", al" all,/
furthcr-4720.
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Asmociate X11vi rorluwnicaj.
j I,' I, ( ) /T.)/j'1j
f
1,11C la
V-1
tr DATE RECEIVED
INSPECTION APPOINTMENTS
TIME ME � � 1 � P,{)� TIME
_Tfi1:.
DATE DATE c DATE
INSPECT _��� INSPEC R INSPECTOTT
i1�11�itrip6I ITT
DEPT. oF
MUNICIPALITY OF ANCHORAGE FNVIRONMEM;,L [;,,'
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION L&TION
825 L Street - Anchorage, Alaska 99501
NAR
3 j980ENVIRONMENTAL
0*
SANITATION DIVISION
Telephone 264.4720 R E C E
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
JUD'17-14 Pic
MAILINn ADDRESS
S 3 6 o (,visit dz A
PROPERTY RESIDENT (If different from above)
PHONE
2. BUYER
PHONE
MAI LING ADDRESS
14��
3. LENDING INSTITUTION
PHONE
A4Ash'A_
ING ADDRESS
_FTEALTOR/AGENT
&MALINGADDRESS
�7 F,
� —
��,e>rr�=��=-N r�� 7� �'z� ,�
_�
,f✓_i��. I ' �, tet,, � �q
�z ;/�j'
5. EGAL DESCRIPTION
o :9 6 1®
STREET LOCATION
p X `:P b M A �Q C cJ.s `3 F,
6. " YPE OF RESIDENCE NUMBER OF,BEDROOMS
>41 SINGLE FAMILY ❑ One ❑ Four ❑ Other
❑ Two ❑ Five
❑ MULTIPLE: FAMILY ,[ Three ❑ Six
7. WATER SUPPLY
INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled
❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITYdepth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
X INDIVIDUAL/ON-SITE** 1-9N.F_YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
1
72-010 (Rev. 6 79)
�C -L6 c.t 9l Aft? 001
s THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ SINGLE FAMILY
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ MULTIPLE FAMILY
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
PERMIT NUMBER
❑ INDIVIDUAL
DEPTH OF WELL
❑ COMMUNITY
DATE DRILLED
❑ PUBLIC UTILITY
Connection Verified_
LOG RECEIVED -
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
❑INDIVIDUAL/ON -SITE
DATE INSTALLED
❑PUBLIC UTILITY
Connection Verified _
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size:, If Tank is homemade
SOILS RATING
give dimensions:
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
Septic/Holding Tank
Absorption Area
Sewer Line
rest Lot Line
Nearest
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
5
t
I
O`' -APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate) el
6 --DISAPPROVED
DATE:
BY
77-nin (Rev. 6/79)
MUNICIPALITY 01 INCHORAGE •mm
POACH 666 ANCHORAGE, ALASKA 99502
1 1 -lQ--
v
REFERENCEO ! _ 4� �G���(7�. /a�-- --'-- ---=
-
To
REPLY DATE FROM
rwONSTIkJCTION
1!
T T LAD
MATERIALS TESTING • QUALITY CONTROL
SOILS ENGINEERING
2204 Cleveland Ave.
P.O. Box 10- 1 12 6
Anchorage, AK. 99511
277-0231
LEGAL DESCRIPTION
PERFORMED FOR:
JUDY RICH
710 Third Ave.
P.O. Box 2540
Fairbanks, AK. 99707
452 -12 67 • 456-5155
LOT 26 , BLOCK ,
OR
8300 Wisteria
Anchorage Al aa' ^ aaROt1
PHONE NO. 24'�OT 7h
SF-r'TIC SYSTEM
ADEQUACY REPORT
JOB No. ACTL 80-1317 �l
DATE OF REPORT
DATE OF TEST
SCHROEDER
12 May 1980
9 April 1980
SUBDIVISION
SECTION —, T_N, R_—W, S. M. , ALASKA
REQUESTED BY:
PHONE NO. —
TYPE OF SYSTEM X[N SEPTIC TANK - SIZE 1500 GALLONS
CRIB OR SEEPAGE PIT (LOG)
❑ LEACH FIELD
NUMBER OF BEDROOMS _-3--
SEPTIC TANK WAS PUMPED X� YES ❑ NO
000+
ABSORPTION RATE: AVERAGE 24 HOURS 1,GALLONS.
SURGE RATE: 750 GALLONS IN 20 MINUTES.
NOTES a OBSERVATIONS:
MUNICIPALITY OF ANCHORAGE
DEPT. OF 1-ALTH &
ENVIRCNMENTAL i i OiECTION
,; U iq 6 1980
R.ECEI
BP BN APPROVED BY:JAMES E. RINGSTA,
TEST PERFORMED BY: REPORT PREPARED BY: —
P.