HomeMy WebLinkAboutRAYMOND TEDROW Block 1 Lot 8 Resubdivided into Black Hill Terrace S/D Lots 1-4 19862_
G' ,1'JR ANCHORAGE AREA BORG, ~"t
AR'FMENT OF ENVIRONMENTAL QUAL~
......... :!500~-!'._U_L)_O1~,. NO~.D. ¢_s,i'~}:_L~UR;\~/;.'/'_~LA.EK.A- 99.5?{ 2_?9-8686 ............................
INSPECTION i;:[rk)Rr r-,,~ q, i 'off/
,., -.,,T. SEWAGE DIS[ ..... L SYSTEM
NAME Daniela Adams B '
~ ~ ox ~37 995/7
................ · ,- ., ........ t z ....................
LOCAiiOF4 ;::,',; :)EcCl. ~,nNLOL 8 Block 1 Ravmolld
SEPTIC TANK:
DISTANCE FROM WELL ,' "!;;,; ......... ~.~ ....... .~ .... _ ..............
~IO~J~D
SEEPAGE SYS[EM: SEEPAGE
LINIhlO MAT RIA
BUILDING f O U,'q[>A flor.' _
...... _ ................. SO. Ff
TII. E DRAIN FIELD:
DiS'rANCE FqO,'.', ,',Ecl ........ ;.'7 ';, ,', l'.
NUMBER :DF N!!ES ~-± . .~.,~:;' ..... ; :~i',';{:i..", . ';E; _ !Ni ~'~i,, v, IDiN - ~': TOTAL EFFECii',,
"-... 11%
{ :',',NC; FR( '.',
WELT: TYPE ............ Dri] led >N~,,, , 2;N(3 /C~uNO.~rlOr-, 290 ..... ' SAMPLE ...... NEARESI
LOT LINE SEWER L;t';E :;.'~< sYsr?,~ -r"sP"" SOURCES
DISTANCES: SOepago, 2, ~ ~!OL1Se ',
- - 60 ' .....
; ..........................
trai lot
290' from trailer
~ 8x8x6' ~
,, ]og cr]lS' ', , :
}', }!O q~'Cr'~'
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPI'. OF [:::'.L'd-I &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'rI~(~'d~iRONM[!N]AL F;LC'iEc'rIoN
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION ALIG 2{ 'J '1979
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW[~Rli~CITLI,~, ElSIJ
DIRECTIONS; Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1, PROPERTY OWNER PFIONE
Ronald Williams 694-3401
MAILING ADDRESS
121 Echo St.~ Eagle Rivep~ AlaSka
PROPERTY RESIDENT (If different from above)
sa. me
2, BUYER
Dean Hoopep
MAILING ADDRESS
2708 West 30th Ave. APt 2
PHONE
PHONE
2?6-5300
3. LENDINGINSTITDTION I PHONE
The Lomas & Nettleton Company I 274-7661
MAILING ADDRESS
4449 Business Park Blvd.~ Aneho~a~e~ Alaska 99503
4.' REALTOR/AGENT I PHONE
N/A
I
MAILING ADDRESS
5. LEGAL DESCRIPTION
Lot 8 Block 1 Raymond Tedrow Subdivision
STREET LOCAT ON
il21 Echo St,
I e. TYPE OF RESIDEI~CE NUMBER OF BEDROOMS
[] One [] Four [] Other
[] SINGLE FAMILY [] Two [] Five
[] MULTIPLF FAMILY [] Three [] Six
7, WATER SUPPLY
~1 INDIVIDUAL* * ATTACH WELL LOG. A well log is required for 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
1~ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date / ()l-ir'~. .
tf system is over two (2) veers old an adequacy test is required
[] PUBLIC UTILITY 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:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
2, WATER SUPPLY
INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
~] INDIVI DUAL/ON -SITE
[]PUBLIC 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:
()NE [] THREE [] FIVE
TWO [] FOUR [] SiX
PERMIT NLIMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
MATERIAL
~ ~ ~ ~ L~ I ,~t-, c'.,~ , t~ - I ~ ~ /-~ ~ l~ ' !~
[] OTHER
Line
Absorption Area to nearest Lot Line
DATE
5. COMMENTS
[~ APPROVED FOR BEDROOMS
CONDITIONAL APPROVAL (letter must accompan~ certificate)
DISAPPROVED
(Title)
~ ·
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274~4561
Date Received 1/28/74
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
VA_
1086 Eagle R'i.v~r
Daniel a Adams
Phone: 694-2R-]4 --
Phone: 694,2701
3. Legal Description: Lot 8, Block 1 Ra,~ Tedrow Subd$
4. Location: Echo St
5. Type of facility to be inspected. .
6. Well Data:
A. Type Drilled
Sinqle_Fami_~y __ No. of bedrooms Xl~ree
C. Construction Standard
Sewage Disposal System:
A. Installed 1972
C. Septic Tank: 1. Size
D. Seepage Pit:
E. Disposal Field: Total length of lines
B. Depth ______~,
D. Bacterial Analysis
B. Installer John Adams
1000 gals 2. Manufacturer Self
1. Absorption Area 16x17x6' 2. Material
, Absorption area
Other contamination
, Absorption area
42'
Satisfactory
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
Loq
, Sewer Lines ,
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Req .... t for Approval of Individual ~ .Jr & Water Facilities
Legal Description
Comments
A pprove~ ~. ~ Disapproved Date ~/~/~
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I 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)
