HomeMy WebLinkAboutTOM FACCIO W2 E2/5
MUNICIPALITY OF ANCHORAGE ' ' iCIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~I~IN DEPT, C',: I~ALTH '&
825 L Street - Anchorage, Alaska 99501 ENVIRON~V~!qT,~,L .~', '!~CTION
ENVIRONMENTAL ENGINEERING DIVISION OEO ~ 3 1978
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
-1. PROPERTY OWNE/~ , ,
PROPERTY RESIDENT {If different from above)
2, BUY_ER ,
MAILING ADDR. ~
[ ENDING ~[~UT ON u
~A~ L~ NG A~ ESS
MAILING ADDRESS ~/ ~
PHONE
5. LEGAL DESCRIPTION
STREET LOCATION
E. TYPE OF RESIDENCE ~/
[~SING LE FAMILY
[~] MULTIPLE FAMILY
NUMBER OF BEDROOM~S
[] One JJ~ Four
[] Two [] Five
[] Three [] Six
[] Other
~INDIVIDUAL*
WATER S LY
[] COMMUNITY
[] PUBLIC UTI LITY
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
~ PUBLIC UTILITY
* ATTACH WELL LOG. A well Icg is required for ail wells drilled
since June 197B, For wells drilled prior to that date, give?~
___ ·
depth (attach Icg if available )'
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72~)10(3/78)
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GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
330 "c" street, Anchorage, Alaska 99503 274-4561
Date Received February 17, 1977
Time
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
of Inspection
voao
l. Approval requested by: Alaska State Veteran's Administration % Larry
Mailing Address: 907 West Northern Lights
Phone: 274-75555
2. Property Owner: Raymond and Grace Gatz
Phone: 272-3235
Mailing Address: 1002 Chugach Way
3. Legal Description: W½ East 2/5 Tom Facci(} Subdivision
4. Location:
1002 Chugach Way
Type of facility to be inspected Single Family
No. of bedrooms 4
Well Data:
A, Type Individual B. Depth 160'
C. Construction ~.~,a-~, D. Bacterial Analysis
7. Sewage Disposal System:
A. Installed Public B. Installer
C. Septic Tank: l. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C.
length of lines
, Absorption area
, Other contamination
, Absorption area
Absorption area to nearest lot line
, Sewer Lines ,
EQ-034
(1/74)
Page I of two pages
Page2 ~f two pages - R~__~st for Approval of Individual~2r & Water Facilities
~egal Descriptiom
W½ East 2/5 Tom Facci~D Subdivision
Comments
Approved ~ /~~] Disapproved Date ~-/*-~7
Appro~q~.~Va]id 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 (1/74)
DEPT. OF H,~'~'LTH & '
MUNICIPALITY OF ANCHORAGE - VtROHMENTAL p~oT~C~tON
DEPARTMENT OF HEALTH AND ENVIRON~flTAL PROTEC~N -'
2510 Ea~ Tudor R~, A~ora¢, A~aska 9950-~ 2~-2221 FE~ t 71977
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES ._ . -
]. Typeof Inspection: CMRO .VA.. ~ FHA CONV
2.
Prope~ Owner:
4. Name of Lending Institution:
Water Supply
Type of Supply: Public Utility. individual
if Individual, number of dwellings presently served. . . /
If Individual, depth of well
Sewage Disposal System
Type of System:
Public Utility
If Individual, date of installation
Individual (on-site)
72-003(3/76)