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Home My WebLink AboutBELLA VISTA #1 LT 21 N2 DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION 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. PROPEJ~Y OWNER . ! ~ t PHOI~IE MAILING ADDR EjSS PROPERTY RESIDENT (If d~erent from above) PHONE MAI LING ADDRESS 4. REALTOR/AGENT ' ' , PHON~ 1 5. LEGAL DESCRIPT/ION STREETb2LOCATI 0~.¢~ 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five ~'~ 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 [] INDIVIDUAL/ON-SITE** ~ PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACC. QMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ..... .Z c / I THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] OTHER Septic/Holding Tank IAbsorption Area [Sewer Line INearest Lot Line 5. COMMENTS DATE DISAPPROVED APPROVED FOR BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) 72~010 (Rev. 6/79) DATE RECEIVED TIME INSPEcToF~¥ ~C~ ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL oF INDIVIDUAL WATER AND MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION FEB 0 1981 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Robert N. Uchitel 276-1200 MAILING ADDRESS '4664 Business Park Blvd.~ Anchoraqe, AK PROPERTY RESIDENT (If different from above) ~X[XX~%~XX~~XX~[ (Same) 2. BUYER none as yet 99503 PHONE 349-6469 PHONE MAI LING ADDR ESS 3, LENDING INST~UTION PHONE 4."R AGE PHONE Rod Pfleiger - Polar Realty [349-7681 MAILING ADDRESS 1101E. 76th Suite B~.Anchora~e, AK 99502 ~-~¢5-q 5. LEGAL DESCRIPTION North 1/2 of Lot 21Bella Vista ~l STREET LOCATION 626 E. 78th Avenue, Anchorage, AK 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five [~ 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 [] INDIVIDUAL/ON-SITE** ~ PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED· NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or I-']Holding Tank Size: If Tank is homemade give dimensions: [] ONE [] TWO PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] THREE [] FIVE [] FOUR [] SIX [] OTHER Septic/Holding Tank IAblorption Area [Sewer Line Nearest Lot Line 5. COMMENTS DATE [] [] [~.-~ DISAPPROVED APPROVED FOR BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) 72-010 (Rev, 6/79) A N C l-i O R A G E, A L. A S K A 9950 t MAYO March 1).~ 19°'1 TO: Whom It Hay Concern Subjec. k; N!';i I,ot 21 Bel].a V].',3La Subdivision ~t A water sample was drawn at the abov'a subject property for bacterJ, al anal. ysis. Tlhe result:s show t:l-'L:~ wat..er is i~ree of coliform ba. ct:er-i.a. If.' there are any' :['u.1;ther ques't, ions~ please call th:is office at 264..-4720. S].ncerely, Roi. ~-:.z: t. C. Prat t ii:i:. ~., ,, 3~ .7t .h .]. ,% ~... zahe Spec '~ '~" '- A,:..,SOC '' ' ~ RC P//1 j W ' : :'!:~,'~.:i:~::::;'; :~: :. ;,':i:.,, :~i:i :; ": ,',i; :i;~.:i MUN CIPALITY O'F ANCHORAGE: ~., op .EALT. RONMENTAL ~, ;~:?~,:~:.,~ ..... , ENVIRONMENTAL ENGINEERING DIVISION :.:,: ~:: ::,:;,~; REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND DI~EOTIOM~ Bom ere ~ ~rts on ~ . ] I.~o~ .~. r.~..s~s ~ II .o~ ~. pro~s.~ P .~s. ~ ow MA LNG ADDRESS '~ ......... ~:~,~.~.~-,:. ~'-~ .~' ~-'~ ..... ~ ~ PROPERT~ RESIDENT (If d fferent 3. LENDING INSTITUTIO~ ~,: LEGAL DESCRIPTION STREET LOCATION 6..,TYPE OF RESIDENCE NGLE FAMILY : BEDROOM.~ 7, WATER SUPPLY ~/-~ weu,l,og ' iMMUNiTY,' iO~ ~ll~'afili~d UTI LITY: g if.available, 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON2SIT[ ~IOTE: THE INSPECTION FEE MUST:ACcOMpANy'EAcH REQUEST BEFORE PROCESSING INITIATED. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS ' TIME TIME TIME DATE I DATE DATE INS~PECTOR INSPECTOR INSPECTOR DIRECTIONS: . . NUMBER OF BEDROOMS [] SINGLE FAMILY [] MULTIPLE ~AMi kY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIViDUAL/ON -SITE F-IPUBLIC UTILITY ...... "' - Connection Verified []Septic Tank or []Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: FOUR PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED .. .~..,: ,,:.- PERMIT NUMBER .... . DATE INSTALLED ' :'. ' .,: -'i_-' ,:,?',:'~ ,':... ' INSTALLER ..... ' MANUFACTURER MATERIAL Absorption Area to nearest Lot Line Nearest Lot Line : [] APPROVED FOR BEDROOMS -- [] CONDITIONAL APPROVAL (letter must accompany certificate) l~_~)lSAPPROV ED .- , ::t~ :.: :,'_ : ,,/: . LEGAL DESCRIPT ON .... , .......................... . ..... ' . · . ;'..: - ~"-.~ ~': ....... .', :..-: ': "'L," ':..:~6~:'~ 72-010 [Rev, 3~78) _ . - ' , - , :. ' . . . 5. -Wate~ Analysis: Distance from well to closest existing or proposed: 1. Sewer line ~' Septic tank,,, ~**m. _. 3, Seepage Ar.aa . ~, Cesspo~l'_~_ /~ ' 5. Property Line /~+ . Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. 7. Sewage disposal system, Se Septic tank capacity in galiot~a "' d~. ~ ~ama of seEt~c tank mam~fact~,~ ~~,. ,~,. ,,' 1. If "home made" show diagram on reVerse aide of this form. Disposal field or seepage pit size and typ~. 1, Distance to property .l_in~ I~' ~ to house ~mda'tion ~0'~' e. Percokatiom Test f. Percolation Test performed by. "-~t~ Use the reverse .side of this form to show diagram. Diagram should include [,?.t, he fo[~owing information: p~operty lines ~ .well location, house location, m~Dtic tank location, disposal area location, location of percolation test, a~ direction of ground slope. 9. The ~r[~'~r~t~on on this form is true and correct to the best of my knowledge. ~ '$i~[~e-o~'~li'~% ..... ~ ' 'j[te TO BE FILLED OIJ'r BY HEALTH DEPARTMENT PERSONNEL The above described sanitary facilities are hereby approved, subject to the ........... ~'l!owin? cond~.t'ions: ............ Conditions: The above described sanitary facilities are disapproved for the followinK ~easons: ., ./L/ , x Approval ~ val%d for one year following the date of approw, 1. CPJ: cw 5[X~,H:CT: 1/2 of Lot 21, [Iell~ ¥ist~ ;iubdivision 11, 626 ~mst 78th Avenue Into~-in approval for the Veteran:: ~ckinistratic~ gould be by ~is t~a~t ~ing t~ esc~ o~ h~s to cover Please ',?gel £ree go coat, act this of££ca for · l~reit to install can issue yea a permit. ^d~ini st~ati uc Oi rector Jat,:ru CC,' Heflin R~alty RECEIPT FOR CERTIFIED MAIL--20~ SENT T,~ ~ POSTMARK OR DATE STREET AND NO. CITY, STATE, AND ZIP CODE EXTRA SERVICES FOR ADDITIONAL FEES Return Receipt DeJiver to Shows to whom Shows to whom, Addressee Only and when when, and where delzvered delivered [] 50~ fee POD Form 3800NO INSURANCE COVERAGE PROVIDED-- See o~her s/de) Nov. 1964 NOT FOR INTERNATIONAL MAIL