HomeMy WebLinkAboutTURNAGAIN BLK 3 LT 5 (3)
-},~NMUNICIPALITY OF ANCHORAGF
DEPARTME~i 'OF HEALTH ,~ND ENV~R~ONMEN'i'~,, PROTECT.L,ON
Date Received: March 2, 1978
#1: Time 11:15 a.m. #2: Time #3: Time
Date 3-6-78 Monday Date
Date
Insp Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Coast Mortgage Corporation
Mailing Address: 4797 Business Park Boulevard Phone:
279-0665
2. Property Owner: Robert G. Sleininger
Mailing Address: Star Route A Box 1388C 99502
Phone: 344-7919
3. Legal Description: Lot 5 and 6 Block 3 Turnagain Subdivision
4: Single Family Residence: ( ) Number of Bedrooms:
Multiple Family Residence: k~ Number of Bedrooms:
Well System:
Permit #
Construction
Individual well ~ Community/Public System ( )
Depth of Well 85' Well Log on File
Bacterial Analysis
( )
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System ( ~ Public Utility
Installed 1967 Installer
Manufacturer
Soils Rate Material
( )
7. Distances: Well to Septic Tank to Absorption Area
to sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Page ~o
- Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 5 and 6 Block 3 Turna~ain Subdivision
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
Approved:
Disapproved
Date:
Date:
Department Worksheet:
· /O~[ Department of Health and Environmental Protection -(~.~
"//~1 ..8~ _2~,'-_'--L-~-'~ _~.~ Anchorage, Alaska ~ ..1~
[[~ 2;,~ c~/~ ~, -/~3~-~ /~ig). 264-4720 ~1..~ I
'~' ~uest for Approval of Individual Sewer and Water FaCilities
Property Owner: /~-~
Mailing Address:
Name of Buyer:
Mailing Address
Phone: ~.?~//
Lending Institution:
Mailing Address: ~ ?~?
Realtor/Agent: ~//z~
Mailing Address: %~]--~ &~ .//~-~a.~,,~ ~z~n Phone:
Legal Description:
Street Location: /~
o
Single Family Residence: ( ) Number of Bedrooms:
Multiple Family Residence: (~ Number of Bedrooms:
Water Supply: * Individual Well (~ Public/Community System
If Individual Well, well depth ~3~,
If Community System, name of system
Sewage Disposal System: *~n-site System
If On-site System, date of installation:.
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
.~est is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
~ ~ /~' · / REQUEST FOR APPROVAL OF '
\[,~[- ~ ~)/ INDIVIDUAL SEWAGE AND WATER FACILITIES
~v~ ~[~y (Fill out in Tmiplicate)
~ Name of person requesting apprg;val
5. Wate~ Ana~is:
c. Casin. Size .....
d. Distance from ~ell to closest existin~ o~ pmoposed:
1. Sewer line
2. Septic tank,, 7~
4. Cesspool'
5. Property Line
6. Other sources of possible contamination, i.e., creeks, lakes,
houses, barn, drainage ditch, etc.
7. Sewage disposal system.
a. Age of system
b. Septic tank capacity in gallons /~
c. Name of septlc tank manufacturer ~7~I ~4~'~:~x~-~
1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage pit size and type
1. Distance to property line to house fo~kndation
e. Percolatio~ Test~cesuLts
f. Percolation Test performed by ..... ,
~... Use the reverse .side of this form to show diagram. Diagram should include
['-~he following information; pFoperty lines;.well location, house location,
~ptic tank location, disposal area location, location of percolation test,
a~ direction of ground slope.
9. The'h~fo=.,r~tion on this form is true and correct to the best of my knowledge.
~ $mgn~ture 'of Applicant Date Signed
\
TO BE FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL
~-~he shove .escrzbed sanitary fac.l.l~tzes are hereby approved~ subject to the
Conditions: ~ ~
The above described sanitary facilities are disapproved for the following
Approval is valid for one year following the date of approval.
CPJ: cw
Distance from well to closest existing om pPoposed:
1. Sewer line
Septic' tank_ ~!
Seepage Area '~
Cesspool'__
5. Property Line
6.
Other sources of possible contamination, i.e., c~eeks, lakes
houses, ba~n, ra~nage ditch, etc.
diagram on ~everse ~tde of this fo~m.
pit size and type ..~XpX~ ~--,
line_, to housefoundatlon'
-e, ?ercolati°n~?est'r~sultS
f, Percolation Test performed by
Use the reverse.side of this form to show diagram, Diagra~ should fnclude
· -~he followzng znfo~matlon: ~operty llnes~.well location, house location,
~p. tlc tank location~ disposal area location~ location of percolation test,
ar,~ direction of ground slope·
The h~fo~tion on this form is true and cor~ct to the best of my knowledge.
'ssgnature of Applicant "' Date Signed
\
~ BE FILLED OUT BY HEALTH DEPART~JENT PERSONNEL
~-~"£he~ above described sanitary facilities are hereby approved~ subject to the
......... ~611owin~ con~ons: '
Conditions: '~')~_~,
The above described sanitary facilities are disapproved for the following
Approval is valid for one yea~ following the date of approval.
CPJ:cw