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Home My WebLink AboutSPRUCE ACRES LT 6OIq--?_sl- I-OOO ,~,~ DATE RECEIVED ' N P C I°N APPOINTMENTS DATE DAT~ L&~Z ~_P )ATE~ ~ ''~ MUNICIPALITY OF ANCHORAGE ~UNfGIPAU~ OF ANCHORAGE 825 L Street - Anchorage, A,aska 99501 ~IRONMENTAL P; - T ON ( E WRON E.TALSAmTAT O"D WmO" [ AY O 1981 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proce~ed, Please allow ten (10) days for processing. 1. PROPERTY OWNER~ ~ ~ ~// , PHONE PROPERTY RESIDENT (If different from above) f PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAI LIN G ADDR ESS 5. LEGAL D SCRIPTION STREET LOCATION / 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] Other '~ SINGLE FAMILY ~ Two [] Five [] MULTIPLE FAMILY Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach Icg if available,) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ~ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PRocEssING CAN BE INITIATED. \ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUIViBER OF BEDROOMS (~SING LE FAMILY [] ONE [] THREE [] FiVE [] OTHER [] MULTIPLE FAMILY [~TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [~I~IN DIVIDUAL DEPTH OF WELL lC UNITY DATE DRILLED UTILITY Connection Verified LOG RECEIVED [~__ 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~]INDIVlDUAL/ON -SITE DATE INSTALLED Conn_~.~.ectio~ Verifi, ed INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemede SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line [~"~APPROV ED FOR ~-- BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate} [] DISAPPROVED 72-010 (Rev. 6/79) CHEMICAL ~ GEOLOGICAL LABORATORIES 0~' ALASKA, INC. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Water System Name Phone Mai}ing Address MO. Day Year Zip Code SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. ) ~ Special Purpose t [] Treated Water [] Untreated Water SAMPLE NO, LOCATION Time Collected Collected By I;:,'o t~(~ TO~E COMPLETED BY LABORATORY Analvs~s shows this Water SAMPLE to be: ~ Satisfactory ~ Unsatisfactory [] ~amDle too ~ong in transit; sample should not De over 48 hours Old at examlna[~on [o ndicate re ~able results Please send Date Received ~ Time Received /'; ''~ ~ Analytical Method: [] Fermentation Tube ,~ Membrane Filter Lab Ref. N0~ Result* Analyst I FTq READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 iD) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Presumptive 1Omi ].Omi ].Omi~ /Omi ].Omi 1.0mi O.].ml , 24 Hours 48 Hours ConflrmatoPJ EMB Broth 24 hours: Multlpre Tube Report: Membrane Filter: Direct Count Verlflcatlont LTB Membrane Filter t 3330 "C" Street, Anchorage, Alaska GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 99503 274-4561 ' ~ ~6~ Time of Inspectio~~~_~ !~~ ,~~ ~2'l ~~ ~'~ Date of inspection ~]3~_(~_c~ } '~,P~V~BUAL SEWERF~.WATER FAg~L~T~ES Mailing Address: ~ ~ ~',.~ ~ Phone: Aqfl-fl~ll 2. Property Owner: ~-~,~. ~,,~,~,,a Phone: &q~-~q~ Mailing Address: ~ ~A,~ ~L ~, ~.~c ', .... 3. Legal Description: ~ ~ ~Pm~,m~ ~PA~ A/~. 5. Type of facility to be inspected X,~~,O,, No. of bedrooms 6. Well Data: ~ A. Type ~,~,,~,A,,,O B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: ~~ ~~ A. Installed B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area 2. Manufacturer 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page '2 of two pages - Requ' ~egal Description oOy,~ ~ for Approval of Individual Se/'-'~& Water Facilities Comments Approved~__~/~oAYAp~ Disapproved Date /~--~--7~ val Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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 (!/74) 3330 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality "C" St., Anchorage, Alaska 99503 - 274-4561 4 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspection: CMRO Name of Buyer: Name of Lending Institution:~ Mailing Address: Name of Realtor or Agent: ....... Legal Description: Type of Facility to Water Supply Type of Supply: If Individual, If Individual, be inspect'ed: Public Utility number of dwellings depth of well Individual presently served Sewag~ Disposal-System Type ,of S~stem: Public Utility V If Individual, date of installation Individual (on-site)