HomeMy WebLinkAboutCREEKSIDE PARK #3 LT 32kSiCi
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MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 NOV 6 1978
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND
;DiRECTiONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (!0) days for processing.
· PROPERTY OWNER
JOhn/Vera Murphy
:~,'! &~ L! NG ADDRESS
J PHONE
*~276-4209/w
7130 Old Harbor Road
333-6544/h
!'F!OPERTY RESIDENT {If different from above)
Post Office Box 1122 99510
BUYER
William Murphy
~.~:~iLING ADDRESS
Same
3, LENDING INSTITUTION
PHONE
PHONE
National Bank of Alaska
PHONE
276-1132/288
,:~i Li!~G ADDRESS
Pouch 7-025 99510
R E ALTO R/AG ENT
PHONE
ADDRESS
3. LEGAL DESCRIPTION
i _L_o~_32__Creekside Park
S F;-:; EE:T LOCATION
'_~_130 Old Harbor Road
~YPE OF RESIDENCE
SINGLE! FAMILY
MULTIPLE FAMILY
~3 Subdivision
?
One L_-~-] Four
Two [] Five
Three ~_~ Six
[] Other
SUPPLY
.... INDIVIDUAL*
~A~ -~OMMUNITY
~-J 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 (att~Cli~log if available.}
SEWAGE DISPOSAL SYSTEM
[:~'-~ INDIVIDUAL/ON-SITE**
~--,-~ PUBLIC UTILITY
**If individual/on-site, give installation date t9~ z~ --.
If system is over two (2) years old an adequacy test is required
by this Departmen~l
",JOT'E: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
, ,_ 1Ci3;'78!
** for contact
THIS SIDE FOR OFFICIAL USE ONLY
DATE R ECEIVEI~
INSPECTION APPOINTMENTS
TIME TIME
' ' E DATE DATE
, ~, L;R INSPECTOR INSPECTOR
]' l i,' ECTICNS:
!. NUMBER OF BEDROOMS
TYPE OF RESIDENCE
_] SINGLE FAMILY
i~_~ MULTIPLE FAMILY
2. WATER SUPPLY
_ INDIVIDUAL
,.ii COMMUNITY
]] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
.] NDIVIDUAL/ON -SITE
] ?UBLIC UTILITY
Connection Verified
!]'] S~}ptic Tank or [] Holding '[an~,
· ::;i;,, ................ If Tank is h~me~ade --
!:.,,, dim,~nsions:
'-', ;'E OF TANK
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SlX
]~STANCES
WELL TO:
. ,- : ~?tior Area to nearest Lot Line
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
:: :_ ,,:, F, SORPTION AREA MATERIAL
Septic/Holding Tank
lAbsorption Area ISewer Line
[] OTHER
Nearest Lot Line
5. COMMENTS ~) . ~ / _ ,~ . ,, /~ _/
· . --
I
~A~..OV~D .O~ _ % ~S?OOMS
~ CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
[A"E 1 BC((Title)
/
I LE'i,,\L
DESCRIPTION
Mailing Address:
MUNICIPALITY ~F ANCHORAr-
Departme~c of Health and Environmen~Nl~~~G~
825 L Street, Anchorage, Alaska D~9~E^~H &
264-4720 ~NViRONMENTALP~OT~O~
uest for Approval of Individual Sewer and W~ ~~ties
Property Owner: ~ '~,F-~... ~ ~_~ ~
Name of Buyer:
Mailing Address:
Phone:
e
Lending Institution:
Mailing Address: ~r~
Phone:
Realtor/Agent:
Mailing Address:
Phone:
Sm
Legal Description:
Street Location:
Single Family Residence:
Multiple Family Residence:
Number of Bedrooms:
Number of Bedrooms:
Water Supply: *Individual Well ( )
If Individual Well, well depth
If Community System, name of system
Sewage Disposal System: *~n-site System
If On-site System, date of installation:
Public/Community System ( )
(/) Public System ( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
1978
~ost 0££ioe Box 1122
Aaahoz'aqe, Alaska 99510
7130 Old Harbor Road
will not bo granted until tls following items have been
( ) A well Xog is submitted to this department.
()
The top of the well casing is sealed with a sanitary
seal so ~hat it Am water tight,
()
The depression or pit around the well ~asing should
be filled with impervious type soil so that it slopes
away from the well casing.
()
The well casing As ~xtended twelve(12) inches above
ground level.
(x)
Expose the well for our inspection to determine prope~
construction, also, to insure the mintnmm requirements
for protective radius from well and sewer.
(x)
The septic ~ank is ~ed with a receipt sulaaitted to
this office.
()
A £our(4) inch cast iron cleanout be installed to the
septic tank or leaching area.
(x)
A p0r~olation test be perffor~d on the existing leaching
area. This will determine if the system is sale,date
ac~ording to National Standards. A list of private firms
who ~erfor~ the test is enclosed.
JACK BENNY'S AND
ANCHORAGE CESSPOOL PUMPING
Star Route A Box 144
ANCHORAGE, ALASKA 99502
344-2632 or 349-1131
I
........................... ~......~,..../...¢........~ 7_7 ................................
I
I
TA:~ I
I
~OLD 8Y FI~OEIVED BY I
TOTAL ~
All claims and returned goods MUST be
~04~7 .ccom,..n,.d ,.,,,.,. ,,,,,.
SERIES
( )
P.E.
PERFORMED FOR:
4303 North Star Street Anchorage, Alaska, 99503 907.279-8056
NEW PHONE NUMBER 276-4113
S0.~L ABSORPTION SYSTEM TEST
LEGAL DESCRIPTION: Z~r ~2 ~-e~,~'Y</e ~,-~ ~z, ~ .
NO-. OF BEDROOMS: ,. -~. RECORDS ON FILE: ,~,~-. ....
DRAINFIELD ~ .., OTHER ~'~,~/ ~-/~ ,,
TELEPHONE:
DATE OF TESTS:/_~,
PERFORMED IN ACCORDANCE WITH JML STANDARD PROCEDURE ACCEPTED.BY
.~i~MUNICIPALITY OF ANCHORAGE, DEPT. OF ENVIROh%IENTAL QUALITY ON~.~~-
WITH TN'E FOLLOWING MODIFICATIONS:
CAPACITY :'
SOIL ABSORPTION S¥STFiM (SAS)
SEPTIC TANK PLUS SAS
John M. I.mnbe, P.E. 4303 Norlh Stm Sleet ~0 Alm~, gg603 g07-27g,8066
JML'
DEP~ BELOw' METER READING GALLONS PIB{PED· TINE .i:. ''i. f :
.: ~ ._,, -/ ~. 12., ~/.. .:.:
. . ,'/;'
.., .... , .' -. ,-..~ ,,,, . :