HomeMy WebLinkAboutSHADY LANE BLK 2 LT 1am
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MUNICIPALITY Of ANCH
.. ,. MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONVIRONMENTAL PROTECTION
�-. 825 L Street - Anchorage, Alaska 99501
t
JUL 2 7 1919
ENVIRONMENTAL ENGINEERING DIVISION
6. TYPE OF RESIDENCE
Telephone 264-4720
RECEIVED
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. PROPERTYOWNER /
'' �' !fJ ._�PJ✓"".S!/+�'rd�Gr �n_s�,�
�fe__MULTIPLE FAMILY
PHONE
/ C� ".j �Y Y
MAILINGADDRESS�S
51? �C%.. ��,>"fi.�d✓.cf 7'fn nJ / A7/k'�4'�-'--�` /d!i
PROPERTY RESIDENT different from
* ATTACH WELL LOG. A well log is required for all wells drilled
PHONE
<(If Fabove)
y
❑ PUBLIC UTILITY
depth (attach log if available.)
2. BUYER -
PHONE
MAILING ADDRESS _
3. LENDING INSTITUTION
❑ PUBLIC UTILITY
PHONE
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
MAILINGADDRESS r"f
Jho/ 'C,
4 EALT R/AGENT
22 /�j /
PHONE
MAILING ADDRESS
5. LEGAL DESC/PTIO/rN•
7-1
/
STREET LOCATION
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
-Atg_. ❑
❑ One Four Other
❑ SINGLE FAMILY
O Two ❑ Five
�fe__MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
❑ INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
11J-�COMMUNITY Q ,A,
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.
72-010(3/78) s
THIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
DATE RECEIVED - -
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2, WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMITNUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
ED PUBLIC UTILITY
Connection Verified
PERMIT NUMBER ; \`
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL T0:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
n�
❑ APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
0:2— DISAPPROVED
DATE
Q'
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
,�kt
(326 'I"'-IRLET
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ANCHORAGE, ALASKA 99507
{, �tt (90 /) 264-41 11
f� � t- .O�,�� /i��l C OHC _ V.AULLIVAN,
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4�I RFVFP< C :'rF\C.nI ONM' N IA _ PROTPCTION
August 3, 1979
Elstun Insurance, Inc.
900 West International Airport Road
Anchorage, Alaska 99502
Subject: Lot 1 Block 2 Shady Lane Subdivision
Approval for your individual sewer and water facilities
can not be granted until the following items have been
completed:
(1) The septic tank pumped with a receipt submitted to
this office.
(2) Expose the septic tank manhole to verify its existence.
Please notify this office for an inspection.
(3) A four(4) inch cast iron cleanout needs to be installed
in the septic tank and/or leaching area.
(4) A percolation test be performed on the existing leaching
area. This test will determine if the system is adequate
according to National Standards. A listing of private
firms performing the test is enclosed.
Please notify this department for a re -inspection when the
noted descrepancies have been corrected. If there are any
further questions, please contact this office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
CC: Spokane Mortgage Company
3201 C Street 99503
Charles F. Johnson
% Gallery of Homes
1709 Bragaw Street 99504