HomeMy WebLinkAboutCREEKSIDE PARK #1 LT 8 & LT 9 E5'p rk
k
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5'o Hq
05 000
~ATE ~ECEIVED: _
INSPECT:_
REQUEST FOR APPROVAL OF
INDIVIDUAL SB?.R A,~E) HATER FACILITIES
FOR
1
C, SIZE
D, CONSTRUCTIOiI__
E, BACT-ERIAL AJ,~I.YSlS.
SB'IAGE DISPOSAL SYSTEM;
A, S~T~C TAf,~K (IF HOi'~:JqADE,, SI-lO'! DIAGR/V,I ON DACK)
APPROVAL REr'UEST FOR srT. ,,",_"CR "'~ "ATER FACILITIES
PAG2 'ID D
o~EP,'t.,,.: PIT
1. s~z~L
2, hI~;I[[G
C. 1)~$POS~ F~FID
2, TOT~ ~N~
~ t ~LL TO SE~IC T~ ~K
~E~ TO SEEPAGE ~I~
C, !'~LL TO S~ER LI~,
D, ~E~ TO PROP~ LI~E. _
F, F~DATIO[? TO SE~IC TN.)K _
F~I~TIO{~J TO SEE~GE PIT__
SEEP~E PIT TO ~~ LINEm
8, O~l~S:
AREA BOROU61t DEPAR'IIMEt-D' OF EHVIRONMEITrAL .CDUALII'Y
INSPECTION APPOINTMENTS
TIME TIME 'TIME L/ '"
DATE DATE DATE
: INSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE ..
· ~U~4J~'IPALiTY
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIU~ OF ~k~CH~RAGE
825 L Street - Anchorage, Alaska 99501 DEPT. OF H~ALTH'"' ~
ENVIRONMENTAL FKOTECTION
Telephone 264-4720 ~OV 2 6 1979
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S~~r~l~l~S
DIRECTIONS: Complete all parts on page 1. Incomplete requ~ts will not be proce~ed. Please allow ten (10) days for processing.
1. PRO~TYOWNE~ ~ ~ /:~ I PHONE
MAILING ADD~ESS ~ /
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAI LING ADDRESS
MAIEING ADDRESS
4. REALTOR/AGeNT PHONE
MAILINQ ADDRESS
5. LEG/~L DESCRIPTION
~TREET LOCATI ON
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four
~ SINGLE FAMILY I~ 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 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] ,ND,V,DUA./ON-S,TE--
[] PUB.C UTI.TY
YEAR ON-SITE SYSTEM WAS INSTALLED.
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
[] SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] ONE [] THREE
[] TWO [] FOUR
[] FIVE
[] SIX
2. WATER SUPPLY
INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[~ PUBLIC UTILITY
Connection Verified
I--]Septic Tank or [] Holding Tank
Size: If Tank is homemade
give dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[] OTHER
Septic/Holding Tank
Absorption Area ISewer Line
INearest Lot Line
[~"~APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
72-010 (Rev. 6/79)