HomeMy WebLinkAboutT13N R3W SEC 28 Lot 1 of 25
APPLIL_~NT FILLS OUT UPPER HAL ONLY
Pro~ertyOwner ~,,¢.-? f?C'~/~ ~ .~1 / '')-- Phone
Buyer
Address (~~ ~ , l~/ ~ ~ '~ ~ Zip Code
Lending Institution., Phone
Realty Co. & A~nt Phone
Add,ess ~ ~ ~ Zip Code
Street Locati~
~ngle Family
~ Other
drilled
June
~ Community For wells drilled prior to that date, give well depth (attach Icg ff available).
~Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
iC~'.~r'~ ¢'~ gad
Date Date Date Date
Inspector inspector Inspector I nspect(~.~.
Field Notes: t1_ . MUNICIPALITy OF ANCHOP. AOE
DEPT. 01: H~AL]'H
ENVIRONMENTAL PROTECTION
~,lA¥ 9 'ig83
REC IV
{ ~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
CONDITIONAL APR OVAL*
( ) ~<-~11~_~
DATE
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72.023
.~UNICIPALI?Y OF A~C~IOR. ~
DEPARTME~~ ~- HEALTH AND ENVIRONMEN,~ >ROTECTION
. ' 825 ~ Street, Anchoraa~, Alaska "99501
264-4720
~/ G-QQ~ .~%~ ~ n~^ Received- OctOber 11, 1977
Date ~~/ Date Date
Insp~A~.~. ~~v~ Insp ~ Insp ' __
REQU~R~APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES ~ ~ ~O~
1. Lending Institution Request: First National Bank of Anchorage ~o~
Mailing Address: Post Office Box 720 99510 Phone: 276-6300/483
2. Property Owner: Richard H/Judi%h A. Swenson Phone: 243-1141
Mailing Address: 2614 East 42nd Avenue
3 o
Legal Description: T13N R3W Section 28 Lot 1 of 25
2614 East 42nd Avenue-- ~,~a h~-
Single Family Residence: (x) Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
Three
5. Well System: Individual well (x)
Permit # Depth of Well
onstruetion
6. Sewage Disposal System: On-site System (x) Public Utility
Permit # ~ ~~~eler
Septic Tank Size Manufacturer
Absorption Area Soils Rate Material
Con. unity/Public System ( )
We l Log on F le
Bacterial Analysis
( )
o
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
Mailing Address:
3. Name of Buyer:
Mailing Address:
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description:
Location:
CMRO VA FHA
P~cha~d H. & Judith A. Swenson
JVtUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
OCT 1_ t 1977
RECEIVED
CONV X
2614 East 42nd Day Phone:
Dick. M. & Helen J. Kim
1200 Cordova Day Phone:
First National Bank of Anchoraq~
P. O. Box 720 Phone:
P. D. Ream (Aetna Realty)
Phone:.
Lot 1 of 25, T 13 N, R 3 W, Sec 28
2614 East 42nd Anchoraqe~ Alaska 99504
243-114]
274-940]
276-6300 ext 483
276-1928
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
Existinq Sinqle Family
Public Utility.
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
No. Bdrms. 3
Individual X
Individual (on-site). ×
Marie Iiams 10/10/77
72-003(3/76)
Page ~Two
,' Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: T13N R3W Section 28 Lot 1 of Lot 25
Affadavit Attached: (') Letter Attached: ( )
Approved:
Disapproved~~ Date:
Department Worksheet: