HomeMy WebLinkAboutEAGLE RIVER HEIGHTS NORTH BLK 3 LT 6
MUNICIPALITY OF ANCH~'<A~
MUNICIPALITY OF ANCHORAGE DEPT. OF ~ L~H &
,~) DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO'I~i[~MEN1AL F?,,3~ECTION
825 L Street- Anchorage, Alaska 99501
JUL 8 t979
ENVIRONMENTAL
ENGINEERING
DIVISION
Telephone 264-47~0 .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 I PHONE
Pau] & Sharon HarrisJ 694-9386
MA~L~NG ADDRESS
~hatsnika Looo F.~]e P~ver. Ak. 99577
PROPERTY RESIDENT (If differen~ from abo~e) PHONE
2. BUYER PHONE
Larry Chase
MAILING ADDRESS
3. LENDING INSTITUTION I PHONE
N.B.A.I 265-2883
MAILING ADDRESS
~;01 W. Northern T,~ah~-.q Ano. h. Ak.
4. REALTOR/AGENT I PHONE
Area Realtors P.O. Box 249I 694-2663
MAILING ADDRESS
R~]~ R~ver. A~. 99577
5. LEGAL DESCRIPTION
STREET LOCT~TION
Ch~t-~ni]~ T,no? F. agl~ River. Ak. 99577
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~] SINGLE FAMILY [~ One [] Four
~ Two ~ Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY [] INDIVIDUAL*
[] COMMUNITY
PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 197§. For wells drilled prior to that date, give well
depth (attach log 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
I NSPECTO R I NSP ECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] 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, DISTANCESwELL TO: Septic/HoldingTank Absorption Area Is~erL,ne INeares~Lor.,~e
Absorption Area to nearest Lot Line
5. COMMENTS
[~ APPROVED FOR 'T' BEDROOMS
[~ CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED "i
DATE BY ITitle) '
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
DAV'i/' ~. , ....
· Sld', ]
]U~,GLF, ]CiVi,',J~, Al~A,%ib'~ 99577
CIVIL
~T]]~/ ] (~ ](.?70 MUNICIPALh'~( OF ANCHORAGE
DEPT· O£ il "LTH &
ENVIRONMENTAL FF:C, TECTION
JUL 1 8 1979
RECEIVED
694-9055 694.
$ & $ ENGINEERING
SRB 196X
EAGLE RIVER, AK ~J9577
MECHANICAL ENGINEERINg CIVIL ENglNE£RIN6
ADEQUACY TESTS
SOIL TESTS
