HomeMy WebLinkAboutDAWN VILLAGE BLK 2 LT 1Drawn Village
Block 2
Lot 1
#014-061-39
PERMIT NO. (
APPLICANT
LOC8TION
LEGAL
~ETERSON CONSTRUCTION.
TE~HCAR ST
DAWN ¥ILLROE
SR8 BOM l?iBX
~44-86~8
LOT SIZE ~.0000 SQUARE FEET
MINIMUM DISTANCE BETWEEN R WELL 8ND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR 8 PRIVATE HELL OR 200 FEET FOR 8 PUBLIC WELL.
WELL LOGS ARE REQUIRED 8ND MUST 8E RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
SPECIFIC~TIONS AND CONSTRUCTION DIAGRAMS ARE AYAIL..RBLE TO INSURE PROPER
IN~TRLLRTION
PERM I'T ~/RL. I D FOF~ O~EE YEAR FROM I S~IJE
I CERTIFY THAT
i: IRM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWER~ AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE,
2: I WILL INSTALL THE SYSTEH IN ACCORDANCE WITH THE CODES.
DEPARTME~
825
L
,UNICIPALITY OF ANCHORAGE~
HEALTH AND ENVIRONMEN ,'F~.?QTECT~N
Street, Anchorage. Alaska 79'~501~'' ~i'~"~"'~
264-4720 . ~ ~ ,
Date Received: October 6, 1977
#1: Time 9:30 a.m. #2: Time
Date 10-11-77 Tuesday Date
Insp Buchholz
#3: Time
Date
Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Alaska Mutual Savinqs Bank % Debbie Johnson
Mailing Address: Post Office Box 1120 99510 Phone: 274-3561
2. Property Owner: Elden W. Pederson
Mailing Address: Star Route A Box 1718X 99507
Phone: 344-8638
3. Legal Description: Lot 1 Block 2 Dawn Villaqe Subdivision
4: Single Family Residence: (x) Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
Three
5. Well System: Individual Well (x) Community/Public System ( )
Permit ~ Depth of Well 100' Well Log on File
Construction .~/t ~ ~ ' ~'"' ~ Bacterial Analysis ,
Sewage Disposal System: On-site System ( ) Public Utility (x)
Permit ~ Installed Installer
Septic Tank Size
Manufacturer
Absorption Area
Soils Rate
Material
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
MUNICIPALITY OF ANCHORAGE , '; "' ',.
DEPARTMENT OF HEALTH AND ENVIRONMENTAL I~RO~EcTI~ON
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
ND V DUAL SEWER and WATER FACII~I~' ,'
1. Type of Inspection: CMRO VA FHA
2. Property Owner:
/
Mailing Address:
3. Name of Buyer: ~7~/~/~ ]~ ,2 p~ ~,
Mailing Address:_
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description: L
Location: j
~ Day Phone:
~"~ .,~-~ "~ ,~ Phone:
~ Phone:
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply;
Public Utility.
If Individual, number of dwellings presently served
If Individual, depth of well J
Individual
!
Sewage Disposal System
Type of System:
Public Utility .-~
Individual (on-site).
If Individual, date of installation
72-003(3/78)
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 1 Block 2 Dawn Village Subdivision
Comments:
Affadavit Attached
Approved: /~. ~v_~~
Disapproved:
Letter Attached: )
Date:
Date:
Department Worksheet: