HomeMy WebLinkAboutMEADOW BROOK Block 6 Lot 12
.r DATI~:~IECEIVED
INSPECTION APPOINTMENTS
TIME TiME TIME J
DATE DATE
,NSPEOTO
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO~LITY OF ANCHORAGE
825 L Street - Anchorage, Alaska 99501 DEPT. OF HEALTH &
( )
T. .pho.. 264-47 0 00T 6 1981
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
MAILING ADDRESS
PROPERTY RESIDENT (If different from abo~ ~ PHONE
~-~" :- PHONE
2, BUYER
MAILING ADDRESS
~ENDING INSTI'r~N ~ ~ ~ PHONE
4. REALTOR/~GENT / / ' " / I PHONE'
~AILING A R ,'
5, LEGAL DESCRIPTION
6, TYPE OF RESIDENCE
J~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
E~] Two [] Five
~[~ Three [] Six
[] Other
7, WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
PUBLIC UTILITY
* ATTACH WELl. LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSThALLED.
,~ PUBLICUTILITY 1[~3- ~-~1 Id~'~z~- ()~b,LE~_~P NJ /)~ ~/~l~,
NOTE: THE INSPECTION FEE MUST ACCOMPANy EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72~010 (Rev. 6~79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON ~SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or []Holding Tank
Size: If Tank is homemade
give dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
OTHER
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
DATE
~ "'"~V,;,~ APPROVED FOR '~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)
Date
MUNICIPAI_ITY OF ANCHORAGE
OF ltEALI'H AND ENVIRONMENI
L Street, Anchorage, Alaska
#2:
279-2511, ext. 224 or 225
PROTECTION
.99501
Date Received:. A~.[~i~__~ 1977
Time ~3: Time
DaLe Date
Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER 1AC1LITIEo
Lending Institution Request: Security Pacific Mortgage Company
Mailing Address: 1101 East Tudor Road Suite 190 Phone: 276-1933
o
4:
4
Property Owner: Sound Construction
Mailing Address:
P bOll e:
Lot 12 Block 6 Meadow Brook Subdivision
Legal Descrzpt~on:
Single Family Residence: ~
Multiple Family Residence:
Number of Bedrooms: 2
Number of Bedrooras:
Well System:
Permit ~
Construction
Septic Tank Size
Absorption Area
Public/Community Syste~m: (x) Individual Well: ( )
Depth of Well _~ Well Log on Fi].e (
~_~/~___.~ Bacterial Analy.sis ~r,z~__~.,~'/~'
Sewage Disposal Sys%em: On-site System ( ) Public Utility
Permit ~ 2 /~.& ~ I lled
~__ ~%ctur er
% Soils~ Rate Material
Distances: Well to S T to Absorption Area
to Sewer Line t/_~~~Le~ll~e Ab sorption Area
'to Nearest Lot Line
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 112 Block 6 Maedow Brook Subdivision
CoKlme~ts:
Affadavit Attached: ( ) Letter Attached: ( )
Approved:
/
Disapproved: Date:
Department Worksheet:
1. Type of Inspection:
2. Property Owner: __
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
/V, UNICIPALITy OF
DEPT. OF HEALTH
ENVIROix" 4E:"~ ~AL PROTEC/'ION
APt J. 5 1 77
RECEIVED
CMRO
Sound Construction
VA FHA
CONY Xx
Mailing Address: unknown
3. Name of Buyer: Charles M. Laird.
Day Phone
Mailing Address: 433 D 7th Anchorage
4. Name of Lending Institution: Securit,y Pacific Mortgage Corp
Mailing Address: 1011 E. Tudor Rd Anchorage 99507 Phone
5. Name of Realtor or Agent: Area Realtors - Virginia Kohflied
Mailing Address: 5437 E. Noz~thern Lights Anchorage A~e
Day Phone 862 6264
276 1933
337 9424
6. Legal Description: Lot 3_2 Block 6 Meadow Brook S/D
Location: NHN Teklanika Eagle River Alaska
7. Type of Facility to be inspected: sfr
8. Water Supply
Type of Supply: Public Utility
No. Bdrms. 2
Individual --~ -
If Individual, number of dwellings presently served
If Individual, depth of well unknown
Sewage Disposal System
Type of System: Public Utility xx
If Individual, date of installation
unkno~n (Briggs Water )
Individual (on-site)
EQ-037 (1/74)
