HomeMy WebLinkAboutLINCOLN PARK BLK 5 LT 22Lincoln Pk..
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~ DATE RECEIVED
,~ INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
MUNICIPALITY OF ANCHO~GE
MUNICIPALITY OF ANCHORAGE DEPt. OF i~E~ALi'i-f &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~iRONM&NTAL P2:OTECTION
825 L Street - Anchorage, Alaska 99501
E V, RO ENTALSA 'TAT ON D V,S,ON MAY 1 19 1
Telephone 264-4720
REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~t~I~~
DIRECTIONS: Complete all parts ou page 1. Incomplete requests will not be processed. Please allow ten (10) days fo~ processing.
~. PR~WUE. ~/ ~ /~ .HON~
MAILING ADDRESS ~ / /~
PROPERTY RESIDENT(Ifdifferentfromabove) , PHONE
MAIkI~G AD--SS
I .HON.
I
MAILING ADDRESS
6. TYPE OF RESIDENCE ! ~' NUMBER OF~BEDROOMS
Ik~'~SINGLE FAMILY (~'One [] Four [] Other__
E~ Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7. WATER SUPPLY
[~NDIVI DUAL~
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. Awell 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 .~..z/
[] IN,~DIVIDUAL/ON-SITE** ~YEAR ON-SITE SYSTEM WAS INSTALLED.
~PUBLIC UTI LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY E~ ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE 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
E~]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ,
Connection Verified
INSTALLER
[]Septic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
1
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
~ DISAPPROVED ,/' )
825 "L" STREET'
ANCHORAGE, ALASKA 99501
(907) 264-41 !!
GEONGE M. SULLIVAN,
M/~YOR
f)[~i'/.: !Mi:¢ '[ OF H~Ai_TI-tAND ENVIP, ON~¢IENT/\I. PRO'II~C'?ION
Hay 26, i981
Thomas H. Reynolds
201 East Firewood Lane
Anchorage, Alaska 99503
Subject: Let 22 Block 5 ]Lincoln Park Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
{1) The water analysis repor~ needs to be submitted
te this office from the Chem Lab, 5633 B Street,
for our review~
(2.)
The well casing needs to be extended twelve(12)
inches above ground level.. This will need to be
reinspected by this office when comp.leted.
If there are any further questions, please call this
office at 264~4720o
Sincerely,
Robert C. Pratt~ R.S
Associate Specialist
REP/1 j w
CC:
FirsL National Bank of Anchorage
Post Office Box 720 99510
% Lana