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Home My WebLink AboutT12N R3W SEC 25 W2SE4NW4NW4NW4 INSPECTION APPOINTMENTS ~ TIME TIME Tl'191E :)ATE DATE DATE INSPECTOR INSPECTOR I NS P E CT~:{,~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 FNVIRONMENTAL PROTECTION ENVI RONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEV~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE PROPERTY RESIDENT (If different from above) PHONE PHONE MAILING ADDRESS / 3. LENDING INSTITUTION I PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAI,"ING ADDRESS / / / / 6. TYPE O~I~'~SIDENCE /~ ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Other__ [] Two [] Five ~ Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required fo~ 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** ~ "~'~ ~' YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 ( Rev. 6/79) / 'rills SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FiVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVI DUAL 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. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS F~APPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~ DATE BY 72-010 (Rev, 6/79) , . · CHEMICAL & GEt,LOGICAL LABORATORIES OF ALASKA, INC. ',~ TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER Z,~ ........ -% Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I,D. NO. Water System Name Phone'No, Mailing Address City State Zip Code SAMPLE DATE: ~ MO, Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreatea Water SAMPLE Time Collected NO. LOCATION Collected By TO BE COMPLETED BY LABORATORY Analvs~s shows this Water SAMPLE to De: [] Satisfactory [] Unsatisfactory [] Sample too ong in transit; sample should Rot De over 48 hours O~d at examination to qdicate reliable results. Please send new samole. Date Received Time Received ' Analytical Method: [] Fermentation Tube ~-E] Membrane Filter Lab Ref. No. Result* Analyst ] r-[-I eNo. of colonies/100 mi. or NO of Po$1[ive pori~ons. READ INSTRUCTIONS BEFORE GOLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD a.m. 24 Hours ALASKA nUlROnm nTAL CONTROL S RUIC S, InC. J~n§inccrJll(j $ ~nuironmcntal $~adJ~s June 4, 1981 MUNICiPALiTY OF ANCHORAGE DEP~, OF HEALTH & Peoples Bank & Trust ENVIRONMENTAL PROTECTION Pouch 700? '~;"; ~'~ 1981 Anchorage Ak, 99510 d~.,h ~2 Seller - ~oersbesnb. r~ RECEIVED Subdivision - Township 12 N Blook - Seotion 25 Lot - W 1/2, SE 1/4, NW 1/4, NW 1/4, NW 1/4 The type of Absorption system is a pit with an unknown area. The system is capable of accepting 600 gallons of water per day. Based upon the test data the system is acceptable For a 3 bedroom home. The septic tank was pumped on 6-4-81 Note: Tank Size = 1000 gallons ur ~4.' 1220 West 25th Auenu¢ · Anchorage, Alaska 99503 · [907) 276-1361 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection 1. Approval requested by: 4. 5. 6. Mailing Address: Property Owner: Mailing Address: [egal Description: Location: Type of facility to be insPected REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES No. of bedrooms B. Depth ~ -~:~ D. Bacterial Analysis Well Data: A. Type ~~ C. Construction Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: B. Installer Size 1. Absorption Area ~ 2. Material E. Disposal Field: Total length of lines -- Distances: A. Well to: Septic tank ~'-S~' × , Absorption area /~ , Sewer Lines'/'~ Nearest lot line ~ ~' , Other contamination./J/~/ B. Foundation to septic tank :'- ?- , Absorption area C. Absorption area to nearest lot line ?o ~ EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Requ:_. for Approval of Individual S~.. & Water Facilities Comments Approved Disapproved Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED ~/~S~dx .. 9~:~/~-~-~ ~- 3/~¢-/~~7~L Date :- ~5- 7)~ EQ-034 (1/74) 3330 July 16, 1974 oR~ATER ~nghORAo~. A~<A Department of Environmental Quality "C" St~, Anchorage, Alaska 99503 - 274-456'1 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES JUL'L '1974 AJ~i Type of Inspection: eMRO VA '~HA CONV xx Property Owner: Mailing Address: Box 10077 Klatt Station Name of' Buyer: Mailing Ad'dress: ~ox 10077 Klatt Station JAMES J. & NAi~CY J. FUERSTENBERG House - 344-3398 D_aoi Phone Business ~-_1_841 D_ a_y_ Phone 344-3398 4. Name of Lending Institution: _The First.N_ational..~_~rik__of Anchorage_ Mailing Address: P.O. BOX 720. Anch. Ak. Phone 279-4481 Ext. 270 5. Name of Realtor or Agent: ....... Mailing Address: Phone Legal Description: s~ k~ F~ MW¼ IN~W¼ MW¼ Section 25, Township 12 North Rahge 3 West, Seward Meridian Location: NHN Foster Road, Anchora_ge~_ Alaska 7. Type of Facility 8. Water Supply Type of Supply: If Individual, If Individual, 9. Sewage Disposal to be inspected: Public Utility number of dwellings depth of well System Type of System: Public Utility If Individual, date of installation Single Family NO. Bdrms, 3 Individual ~ presently served one Individual (on-site) 1965 MX Please return to: Jane Wojtusik, Real Estate Department HEALTH AUTHORITY APPROVAL 1974 ' .,.~~NDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM /Please Retur.n to:~ Mr~_s. Jan?___Woo tusik~ INSURING OEFICE PART I.~TO BE COMPLETED BY FHA MORTGAGEE tSERIAL NO. The First National Bank of Anchora e MORTGAGOR OR SPONSOR James J. & Nancy J. Fuerstenberg PROPERTY ADDRESS NHN Foster Road, Anchorage, Alaska SUBDIVISION NAME BLOCK NO. LOT NO. South ~ West ~ East¼ NW~ NW~ NW¼ Section 25, T12N R3W, Seward Meridian TOTAL NUMBER; BASEMENT [] New installation WATER SUPPLY DY: ]Public system SEWAGE DISPOSAL --]Public system [] Yes ~]. No --]Community system J~J Community system additional bedrooms? (If Yes, how mony~) [] Individual [] Individual SYSTEM DESIGNED FOR UlYes PART II.~TO BE COMPLETED BY HEALTH DEPARTMENT 4EALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [] County [] Local Department of Health that this individual water-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [] State [] County [] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [] Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily is not likely to create an insanitary condition ~ATE J S,GNATURE ]TINE I I NOTE: The health authority should complete the appropriate opinion statement above and affix date, signature and title in the PART Ill.--FOR USE OF FHA OFFICE I'O TI4E CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable [] Not Acceptable. SIGNATURE ] CHIEF ARCHITECT ] DEPUTY FOR CHIEF ARCHITECT DATE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 257~ Rev. July 1958 ' I