HomeMy WebLinkAboutT13N R3W SEC 26 LT 1 OF 28 & 29
APPLICANT FILLS OUT UPPER HAL -ONLY
Buyer
Address Zip Code
Phone
Lending Institution
· Zip Code
Address
Phone
Realty Co. & A~nt
Address Zip Code
Type of Resi~noe
~ingle Family
~ Multiple Family NO. of Bedrooms _~
: Other
Water SupplyJ ¢&at ,.~f~ ~) O'~ ~)~ ,{~.~ (_?el ,
~qndividua, A~ACH WELL LO,. A';~'['I~ i~'re~ired for all wells drilled since June 1975.
~ Community ~. ~ · For wells drilled prior to that date, give well depth (attach Icg if available).
Sewer Disposal ~;~,~A t ~ " I O~ ~ ~
~ Individual Year Individual Installed:
~ublic Ut]J~y When Connected to Public Utility: ?
~ Holding Tank
NOTE: TH~ INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONM~N1AL PROTECTION
RECEIVED
72023(3/E~)
GREATER ANCHORAGE AREA ~ROUOH.
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274~4561
Date Received January 26, 1977
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Cony.
11:00 a.m.
1-27-77 Thurs.
Buchho 1 z
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
Alaska Statebank
310 East Northern Lights
Gerald A. Andrews
3845 Baxter Road (they
Phone: 279-7637
Phone: 333-7244
live next door tothis add,ess)
3. Legal Description: ~N R3W Section 26 Lot 1 of Lot 28 and 29
4. Location:
3845 Baxter Road
No. of bedrooms 3
5. Type of facility to be inspected Single Family
6. Well Data:
A. Type Individual B. Depth 88'
D ~acterial An~_~si s
c. C0nstr.cti0n
7. Sewage Disposal System~--u~
A. Installed B. Installer'
1. Size
2. Manufacturer
1. Absorption Area 2. Material
Field: Total length of lines
Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area
, Other contamination
, Absorption area
C, Septic Tank:
D. Seepage Pit:
E. Disposal
Distances:
A. Well to:
, Sewer Lines ,
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
· ['~:~PT, OF HEALTH &
ENVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION .... 6
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 JAN ~ 1977~
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
RE EI LE.Q --',
Day Phone:
1. Type of Inspection: CMRO. VA ~ FHA_ ~CONV.
2. Property Owner: /%. !4 A.
Mailing Address: ,~8 zJ ~' EbaX-l.~.r. ,.
. . . ~'~" ~
Mmhng Address. ~ ~ ,5 ,b ~ ,~-(~.~C~.~ ~ D~.. Day Phone:
Mailing Address: *~[O ~., ~)¢ Y' f)* ~.~rl J-./~) ~'.~ Phone:
J. .~ ~
=. ~- ~. .~ ... .
Mailing Address: /D I L .... :[~ffl-~ ~lY?r)~ ~ Phone
7. Type of Facility to be Inspected: ¢~0~¢1 ~' NO. Bdrms. , ~
8. Water Supply
.~,
Type of Supply: Public Utility Individual [
If Individual, number of dwellings presently served
If Individual, depth of well /~¢ 'fY%· ~."'*
Sewage Disposal System
Type of System: Public Utility
Individual (on-site)
If Individual, date of installation
72-003(3/76)
~ ........ ~ of two pages Req~% for Approval of Individual S~r & Water Facilities
-
Legal Description T12N R3W Section 26 Lot 1 of Lots 28 and 29
Comments
Ap~oval 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
Date
EQ-034 (1/74)
