HomeMy WebLinkAboutT13N R3W SEC 13 Lots 1 & 2 of Lot 107L, T
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
~ CERTIFICATE OF INSPECTION
SEWER AND WATER FACILITIES
1. PROPERTY OWNER
Jack Young
MAILING ADDRESS
6633 De Barr 99504
2. LEGAL DESCRIPTION
T13N R3W Sectio~ 18 Lot ~ and 2 Of Lot 107
3. TYPE DWELLING
~ SINGLE FAMILY RESIDENCE [~] OTHER (Describe)
MULTIPLE FAMILY RESIDENCE
4. WATER SUPPLY
~ INDIVIDUAL
E~ COMMUNITY/PUBLIC
5. SEWAGE DISPOSAL
INDIVIDUAL/ON-SITE
PUBLIC UTILITY
HOLDING TANK (Maintenance Required)
~ APPROVED FOR four BEDROOMS
E~] CONDITIONAL APPROVAL (See Attached)
E3 DISAPPROVED
SE.AL
October 19~79 ~ ~
72-014 (3/78)
MUNICIPALITY O?
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEJ~I~I~,tONMENTAL
825 L Street - Anchorage, Alaska 99501 ~l~, ~ -
SEP 1 4 t979
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 RFCEIVED
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. PROPERTY OWNER
PROPERTY ~ESJDE~T (If different from above)
2, BUYER
PHONE
PHONE
MAILING ADDRESS
4. REALTOR/AGENT
JPHONE
~ ~.~EGAi DESCRIPTION
STREET LOCATION ~/
8. TYPE OF ~mDENO~ NU~BE~ OF BED~OO~S
~ One ~ Fou~ ~ O~her __
~ SINGLEFA~ILY ~ Two ~ Five
~ ~ULTIPLE FA~I.LY ~ Throe ~ Six
7. WATER SUPPLY
~ INDIVIDUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled pr or to that date, give well
[] PUBLIC UTILITY depth (attach Icg 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
INSPECTOR INSPECTOR 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 UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
E]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 Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
~__....~'APP R OV E D FOR , BEDROOM/~
[] CONDITIONAL APPROVAL (letter must ~cc~mpany certificate)
72-010 (Rev, 3/78)