HomeMy WebLinkAboutHANSON ACRES #1 BLK 1 LT 10 MUNICIPALITY OF ANCHORAGE ~ ~ '. ..... i
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI;0~ i ,: :,-, ,; ',;~;:.~ , . . mr
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION ....... ' '
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 I PHONE
Hatton, RodneyI 278-3201
MAI LiNG ADDRESS
203 V~.qt Potter Drive Anchorage, Alaska 99502
PROPERTY RESIDENT (If different from above) PHONE
Same as above.
2. BUYER PHONE
Butcher, John and Diane 349-4334
MAILING ADDRESS
SRA-A Box 4058F Anchorage, Alaska 99510
3. LENDING INSTITUTION I PHONE
United Bank AlaskaI 276-1911 Ext.21~
MAILING ADDRESS
645 G Street Anchorage, Alaska 99501
4. REALTOR/AGENT I PHONE
SeleCtive Realty/ Lawarence RobertsI 279-8625
MAILING ADDRESS
1515 East Tudo.r suit 10 Anchorage,. Alaska 99503
5. LEGAL DESCRIPTION
Lot 10, Blk. 1, Hanson Acres #1
STREET LOCATION
203 Potter Drive Anchorage, Alaska 99502
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four
[] SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
F'+I INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
**If individual/on-site, give installation date
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,
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY "
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR~ INSPECTOR INSPECTOR
DIRECTIONS:
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
F-IPUBLIC UTI LITY
Connecti~)n Verified
INSTALLER
F-ISeptic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[};~PPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE ' BY (Title) j'~
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
333~'
~~ Date Received
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
l. Approval requested by: F'irs~.-National Bank of Anchorage
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
Street, Anchorage, Alaska 99503 274-4561
November 1, 1976
Time of Inspection 1:30 p.m.
11-2-76 Tues.
Buchhoiz
Mailing Address:
Post offfice Box 720
Phone:
2. Property Owner: Donald J. Devlin
Phone: 277-4707
Mailing Address: 203 East Potter Drive
3. Legal Description:
Lot 10 Block 1 Hanson Acres #1
4. Location:
203 East Potter Drive
5. Type of facility to be inspected Single Family
6. Well Data:
A. Type Individual --~-- B. Depth 95'
c. C0nstructi0n
·
7. Sewage Dispos'a~ys~em: . ru~4~ y~
B. Installer
e
A. Installed
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank , Absorption area
Nearest lot line , Other contamination
B. Foundation to septic tank
2. Manufacturer
2. Material
No. of bedrooms 3
, Absorp{ion area
, Sewer Lines
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA '~'~
2. Property Owner:
Mailing Address:
3. Name of Buyer: ~'-~O)3,~.-v ~)-~_ -~-A-~
Mailing Address:
Name of Lending Institution:
Mailing Address:
§. ,Name of Realtor or Agent:
Mailing Address:
6. Legal Description: Lr~--r [O~,
Location: ~)r,~ ~
FHA CONV.
Day Phone: L-'~U'~-470-7
Phone:
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
Public Utility. Individual
If Individual, number of dwellings presently served ~
Iflndividual, depth of well ~-"~- ')~/ q~'/
9. Sewage Disposal System
Type of System:
Public Utility
Individual (on-site).
If Individual, date of' installation
72-003(3/76)
.Page 2' of two pages ~
- Re{:' ;t for Approval of Individual S~-~.r & Water Facilities
;'Legal Description. Lot 10 Block 1 Hanson Acres #1
CommentS'.
APProved
Disapproved ~~_% Date /-
Approval ~Valid for one year from date signed
Greater Anchorage Ar~a Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
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)
INDIVIDUAL S~WAGE AND WATER FACILITIES
5e
a, Bacterial .
d. Dis,ance f,om well ,o closest ' ' 'ex/stln, o, p,opose,.U'~_'~' '
/ C, Casing Size~ .
1.' Sewer line . ' ~ , ~ .. ~
3. Seepage Ar, el" ~
~. P~ope~y Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc.
Sewage disposal system. ,]y~/
a. Age of system ,.
b. Septic tank capacity in gallons,
1. If "home made" show d,iagram on reverse side of this form.
Disposal field or seepage pit size and type
c. Name of septic tank manufactu~gr
de*
1, Distance to property line
e, Percolation. Te'~t ~esults
f. Percolation Test performed by. ,
Use the reverse side of this form to show diagram. Diagram should include
~he foilowing information: p~operty lines;.well location, house location,
~pt£c tank location, disposal area location, location of percolation test,
and direction of ground slope.
The ir~formation on this for~., is true and correct to the best of my knowledge.
S~nature of/~pi~cant Date Si~ned ~
TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL
he above described sanitary facilSties are hereby approved~ subject to the
~ollowihg con~illons:
The above described sanitary facilities are disapproved for the following
reasons:
'Signature of
~-' ;. 'Date
Approval is valid for one year following the date of approval.
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