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HomeMy WebLinkAboutKLUANE TERRACE TRAILER EST #2 BLK 1 LT 1113 3. 5. REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Tripli~_ lla,~ of person requesting approval ~;_ ;~,,:~ ~'~,,~ of property,owner ~-~. ~ .bedrooms in house Wate~Analysis: a, Bac%e~.ia]. b. Detemgent . Well data: a. Type b. Depth c. Casing Size Distance from well to closest existing or proposed: 1. Sewer line 2. Septic tank 3. Seepage Area 4, Cesspool' 5. Property Line 6. hoUses~ barn, drainage ditch, etc. Sewage disposal system. Other sources of possible contaminations i.e.~ creeks, lakes~ a. Age of system b, Septic tank capacity in gallons c, Name of septic tank manufacturer 1. If "home made" show diagram on reverse side of this form. Disposal field or seepage pit size and type 1. Distance to property line to house foundation · e, Perco]a%io~.Test'~esults f. Percolation Test performed by Use the reverse side of this form to show diagram. Diagram should include · The fo]_%owlng information: p~operty lines~.Well location~ house location, ~ptle tank location, disposal area location~ location of percolation test, an~ direction of ground slope. 9. The h~'for,~tion on this form is true and correct to the best of my knowledge. Signature of Applicant Dat'e Signed \ TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL '~The above described sanitary facilities are hereby approved, subject to the Conditions: The above described sanitary facilities are dls~pproved for the fOllowing reasons: £ ?'Signature of ~,f-~i"¢f&?l?..: ~:' .... ' ,.':~ ~. Approval is valid for one yeam following the date of approval. CPJ:cw FROM: TO: GREATER ANCHORAGE AREA BOROUGH DEPARTMENT: .D..e...~__r.~m.e..n~_.,~f.,.En~zzonmen~ak. Qualz~z..,....,. SUBJEC: ~a~es INITIATED BY: .~.~.. ~¢~.~.&S~.~..~D~eC~ DATE OF MEMO: DATE ANSWER DEPARTMENT: ~C~ RECEIVER: Environmental Health REQUESTED ACTION SCHEDULE FOR INFORMATION ONLY ~ PREPARE BACK-UP INFORMATION ~ CALL ME BEFORE YOU ANSWER FOR IMMEDIATE ACTION FOR YOUR CONSIDERATION ~ NEED YOUR RECOMMENDATION OTHER Transmi~ed..~he~awtth.~fo~.~.your:-,~re~ia~.and-,~c~n%~,is~,ene~..se%.-ef FROM: GREATER ANCHORAGE AREA BOROUGH DEPARTMENT: INITIATED BY .................... SUBJECT: ~P~ O-.V.~.. -0~.,.,~ .~.~ ................... DATE OF MEMO ........ ~-~/~. .......................... TO: DEPARTMENT: DATE ANSWER ....... ~V.~..~_.me~ r~_~ ~..~ ~. ......................... REQUESTED: RECEIVER: ............................................................................. REQUESTED ACTION SCHEDULE ~% PREPARE BACK-UP INFORMATION FOR INFORMATION ONLY ~ CALL ME BEFORE YOU ANSWER FOR IMMEDIATE ACTION FOR YOUR CONSIDERATION ~ NEED YOUR RECOMMENDATION OTHER Submitted f.~ y~m. review are 2..s~.ts. of p~s....o..f Klu~.e..~ %9.r..~.a.~9..%.r..~.i.%e~..z.'.. ........... we .plam.~to adv~rtise. A~g~.~_.~, 197t~ Please forward to 8he 8tare after yo~t~ .approval ~'" M-(5-67) DIVISION OF PUBLIC HEALTH. ~_~ APPLICATION FOR APPROVAL OF PLANS Alaska Department of Health and Welfare Branch of Environmental Health Pouch H Juneau, Alaska 99801 City ~ip Code "Mailing Address Application Date Business Telephone No. RE:____K_lua_n_e_..T_.e..r_r_ a_c.e.. T_rai. ler_ .E~..t~%~..~q ........................................ (Name of vroJec[ for which approval or plans is requested) In accordance with Alaska Statutes, Title 18, "Health and Safety", Chapter 05, Sec. 18.05.040, (11), (12), and rules and reg- ulations promulgated thereunder, we, ....... _' ...... . .T._h_e _ G r e..a...t~e r. _ ~.n.. 9_ .h_°_r_..a. g .e. _ _A_r...e..a......B_o-.~.~ ~h (lqarno of Applicant) herewith submit for your review and approval, with respect to SANITARY FEATURES, duplicate sets of complete plans for the proposed project described below. "Complete plans" shall be taken to mean General plans, Detailed plans and speci- fications, and a Project Report (Engineering or Architectural Report) including necessary data required for full understand- lng of SANITARY FEATURES of design. (Give complete but brief description of project) h- Barnard - Dowlin~ & Assoc. ' These plans were prepared _~ ...................................................................................................................... . .................. (NalliO of Designing Engineer, Architect or Firm) 999 Tudor Road .................................................................. and by or under the direction of the following Engineer(s) or (Address) Architect(s) duly licensed to practice in Alaska: 754-E _E~r~_Jtaraar~__._: ....................... C&v'f I .Enginaa~ ..................................................................... ~AME) (TYPE OF ,LICENSE (Civil, Mechanical. etc.) Certificate of geg~stranon No. This project is to be financed in the following manner: (List sources of funds and amounts)/' Sources of funds: Amounts: Assessments _ Total estimated cost of this project is $ .......... $_.6.4.~_~.0_.0_..00 ............. These plans are being submitted to you at least one month prior to the contemplated date of a~lvertising for bids .8/_! 7/71_ fi)ate bids will be called) We understand that construction shall not be started until your final approval of these plans has been received; that no revisions in the plans affecting the SANITARY FEATURES of the project may be made subsequent to receipt of your final approval unless such revisions be submitted and approved; that construction will be carried out in accordance with the approved plans; and that unless construction on this project is started within a two-year period subsequent to your approval, such approval will become void. Very truly yours, .... (Signed) (Official Title) ...................................................................... GREATER ANCHORAGE AREA BOROUGH HEALTH DEPART~ENT WATER AND SE%~ER SURVEY Establishment Location Mailing Address TyPe Establishment WELL DATA: Depth t Monthly Samples SEWER DATA: Septic Distance To Well REMARKS: ~'o©e $~9 ,,..,~,~, Ces~poo~ Owner/Manager ~ HOT LINE · H~OUSING PUBLIC FACILITIES ~/ Greater Anchorage Area Borough Department of Environmental Quality COMPLAINT AND ACTION FORM AIR POLLUTION CASE NO. JUNK AUTOS DATE ~./~.NOISE SEWER & WATER COMPLAINTANT: ADDRESS: NATURE OF COMPLAINT: NUISANCE INVEST: OTHER LOCATION OF COMPLAINT: f{./Yl~lx'~..xL.,.-t M~. tl~'.,. .,'~ . RESPONSIBLE PARTY ~ C}l-,-- /[ ~ ~- I~ ADDRESS ' PHONE NUMBER ( RECORD OF CONT/ACTS AND CORRESPONDENCE Date TimeComments /Z /,., .... ~ .......... l,,_ ~. ~ ,:- -, ~ ~ :. . / -:, y ,' !:./ TIME & DATE CoMPLAINTANT CALLED BACK Use Reverse Side of Form for Further Comments