HomeMy WebLinkAboutPLEASANT VALLEY BLK 4 LT 20 (2)
CONSTRUCTION AND OPERATION CERTIFICATE
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION.
PUBLIC WATER SYSTEM
APPROVAL TO CONSTRUCT
Plansfortheconstructionof Pl<"$c~~Jr Vn ll~
by
public water system located
,, Alaska, submitted in accordance with ]8 AAC 80.~00
have been reviewed and are
~ approved.
E] conditionally ap?7 (see attached condi, lions).
If construction has not started within two years of the aPproval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGEORDERS
Change (contract order no,
or descriptive reference)
Approved by Date
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
the public.
APPROVAL TO OPERATE
The construction of the ~t~O~,'~¢[)~-(l~/~' Lo+ ~O ~'~(-~ ¢~-- ~ public
water system was completed on ~ -- ~ ~ (date). The system is hereby
gra~ed interim approval to oper~e for 90 days following the cpmpletion date.
T~LE DATE
As-built plans submi[ted during the interim approval period, or an inspection by the Department has
co~firmed the system was constructed according to the approved plans. The system is hereby granted
final approval to operate.
BY DATE
~ 7% . [~,~v''f~ :-~,
I ENGINEERS
PLANNERS
!SURVEYORS
i 2820 "C" STREET, SUITE NO. 3
! ANCHORAGE, ALASKA 99503
! PHONE (907) 272-9231
SURVEY CERTIFICATION: I hereby certify that I have surveyed the property shown an6 described hereon and that the
improvements situated thereon are within the property lines and no encroachments exist other than noted.
NOTE: ~t is the contractor's responsibility to check top of foundation in relation to finish grade and building setbacks
relation to lot lines and easements.
LEGAL DESCRIPTION:
LEGEND:
~ 5/B REBAR SET
0 5/8 REBAR FOUND
CHKD:
I · , ' '~ DA~ ~ f~ECEIvED
- ' ' INSPECTION APPOI NTM ENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE tV~UiVIC/~,A~y Q~A~,
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchoi'age. Alaska 99§01 ~ V I R O~t~ ~ ~ ~j~ ~'~L~T~ ~ ~.
"~' PROTECTION
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWL~
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow.ten {10} days for processing.
1. PROPERTYOWNER I PHONE
Anthony and Robin QuisenberryI 333-7097
MAI hi NG ADDR ESS
3240 Skipper Drive, Anchorage
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
- Clinton Fick ~ ~j~o~o ~ ~co~o (p~_oc~ 337-2772
MAI LII~G ADDRESS
8001 Little Dipper
3. LENDINGINST[TUTION I PHONE
Alaska Continental BankI 562-0880
MAILING ADDRESS ............
4300 B Street #201, Anchorage 99503 ~/~"~' ........
4. ' RF~A.LTO R/AG ENT i ~.~~.. ~ .~~' PHONE
v~v~an E. dayton 276-2761
MAILING ADDRESS
2702 Gambell
5. LEGAL DESCRIPTION
Lot 20_~ R~ &
STREET LOCATION
3240 Skipper Street
6. TYPE OF RESIDENCE NU~vlBER OFtBEDROOMS
[] One [] Four [] Other
[] SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7, WATER SUPPLY
[] INDIVI DUAL* * 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 UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**~v'~ ~ '~ YEAR ON-SITE SYSTEM WAS INSTALLED.
:~ PUBLIC UTILITY ~J.Z~ /-! ~ -~¢7c
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[]~'~NG LE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[]....' INDIVIDUAL )EPTH OF WELL
[~ COMMUNITY
DATE DRILLED
[] PUBLIC UTi LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
~]INDIVIDUAL/ON -SITE/-/4 '~ DATE INSTALLED
~UBLIC UTI UTY
Connection Verified INSTALLER
~Septic Tank or ~ Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTIQN AREA MATERIAL
4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line ~ Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS ~ /
~PPROVED FOR ~ BEDROOMS
~ CONDITIONAL APPROVAL (letter must accompany certificate)
~ DISAPPROVED
72-010 (Rev. 6/79)
January 1'7, 1984
Anthony and Robin Quisenberry
3240 Skipper Drive
Anchorage, AK 995
oub]ect: Lot 20, Block 4, Pleasant Valley
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
o A well log su~itj~<~ to this office for our files and
review.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
JR20/ej/E1
Jim Roberts
Associate Environmental Specialist
AppLIy 'NT FILLS OUT UPPER 'liAr-' ONLY
'Property Own6r-T~-~ F-/~..~ ,(.
Address
ZipCode ~'~J~ 2
Zip Code
hone
B..yCo.&A t
Address
Type of Residence
[] Other
Water Supply
~] Individual
[] Public Utility
Sewer Disposal
[~ Individual
~Public Utility
[] Holding Tank
Zip Code
Phone
Zip Code
Phone
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
For weUs drilled prior to that date, give well depth (attach log if available}.
" Year Individual Installed: / ~' t~ ~.~ ¢~/
When Connected lo Public Utility: ~ / .~ (~'o ~
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time / Time Time Time
Dat~.,~L~ ~__~,,/ Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: l..(_,~ ,~.~"..~.j.g...(~p..~.~:~ ~.c~..~¢¢~.~c~'L.'~/~-,'~-- .~, ~'~_~,~C-
(~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) C DITIONAL APPROVAL*
Soils Rating Date Sewer Installed Well TO Absorption Area Well Log Received
Well to Tank Septic T~k Size
72-023 (3182)
