HomeMy WebLinkAboutMCCAUGHEY BLK 1 LT 3
MUNICIPALITY OF ANCHORAGE DEPT. OF H~ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEcTI~I~IIVIRONMENTAL P~o'rECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION JAN 3, 1 1979
Telephone 264-4720 R EC E IV E D
REGUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page i, Incomplatg requests will not be processed. Please allow ten (i01 days for processing.
1. DaroPROPERTYOWNER (~ere . PHONE
ld/Gwen 344- 6243
MAILING ADDRESS
6839 Stella place 99507
PROPERTY RI~SIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS ,
3. LENDING INSTITUTION I PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT I PHONE
Jon C. Dawson % Jack White CompanyI 277-1553
MAILING ADDRESS
3201 C Street ~99503
5. LEGAL DESCRIPTION
Lot 2 and 3 Block 1 Mc Caughey Subdivision
STREET LOCATI ON
6839 Stella Place
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four [] Other
[] SINGLE FAMILY [] Two ~ Five
::IIFX MULTIPLE FAMILY [] Three [] Six
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
~X INDIVIDUAL/rON-SITE**
[] PUBLIC UT LITY
**If individual/on-site, give installation date 1971
If system is over two [2) years old an adequacy test is required
by this Department.
72-010(3/78)
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
/ -~' THIS SIDE FOR OFFICIAL USE ONLY
' 'J DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR ' ~ . INSPECTOR INSPECTOR
DI R ECTIONS:
1. TYpE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[:::] MUL~'IPLE FAMILY [] TWO [] FOUR [] SIX
· PERMIT NUMBER
2; WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY DATE DRILLED
[] PUBLIC UTILITY
_ , Connection Verified~ , LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[] PUBLIC UTI LITY
Connect on Verified
INSTALLER
'l-qS~ptic Tank or [] Holding Tank~
S)ze: If Tank is homemade ] SOl LS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ~BSORPTION AREA MATERIAL
AbSorption Area to neal;est Lot Line
5 COMMENTS'
[] APPROVED FOR BEDROOMS
, [] CONDITIONAL APPROVAL (letter must accompany cert ficate)
~LL_-DISAPPROV ED
DATE " BY(Title)
Ir'i=G~,L DESCRIPTION '
72-010 (Rev. 3/78)
MUNICIPALITY OF ANCHORAGE '
//O~~/ 825 L Street, Anchorage, Alaska 99501
'~'~'~ uest for Approval of IndividuaI Sewer and Water Facilities
Property Owner: Darold and Gwen Gere
Mailing Address: 6839 Stella Place, Anchorage, AK 99507 Phone: 344-6243
Name of Buyer: Unknown
Mailing Address: Unknown
Phone:
Lending Institution: Unknown
Mailing Address: Unknown
Phone:
4. RealtOr/Agent: Jon C. Dawson of Jack White Company
Mailing Address: 3201 "c" st., Anchorage, AK 99503 Phone: 277-1553
o
Legal Description: Lots 2 and 3, Block 1, Mcaughey Subdivision
Street Location: 6839 Stella Place
Single Family Residence:
Multiple Family Residence:
( ) Number of Bedrooms:
(~ Number of Bedrooms:
Water Supply: *Individual Well
If Individual Well, well depth
If Community System, name of system
( ~ Public/Community System
68+/-
Sewage Disposal System: *~n-site System (x)
If On-site System, date of installation: 1971
Public System
( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
**If on-site sewer system is over two(2) years old, an adequacy
.test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77