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HomeMy WebLinkAboutTERRACE ON THE LAKE #1 BLK 5 LT 7 , MUNICIPALITY OF ANCHORAGE DEP,T,. REQU DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~T~I~ .~I,©j~i,',EF~T,\L ~;~ ;ECTIO[~ 825LStreot-Anchorage. Alaska 99501 .... p~y Q ~ ?)7~ ~ - ENVIRONMENTAL ENGINEERING DIVISION ...... Telephone 264-4720 E FoR APPROVAL OF IND;VlDUAL WATER AND SE~ ~A~)LYT~S 31RECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing, 1. PROPERTYOWNER J PHONEZS§-2971. National Bank of Alaska. Executor for the Estate of Mable H. Crawfo~d (Helen Barg3c MAILING ADDRESS P.O. Box 600 Anchorage, AK 99501 PROPERTY RESIDENT (If different from above) 2. BUYER Douglas Trail MAILING ADDRESS 1006 "G" Street Anchorage, AK 99501 PHONE PHONE 265-0223 3. LENDING INSTITUTION Coast Mortgage PHONE MAILING ADDRESS 4~R~ALTOR/AGENT J PHONE MAI LING ADDR ESS 5, LEGAL DESCRIPTION Lot 7, Block 5 Terrace on the Lake Subdivision STREET LOCATION 3949 Caravelle Drive Anchorage AK 99503 $. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other~ [] SINGLE FAMILY :~ Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY [~ I NDIVI DUAL* * ATTACH WELL LOG. A well log is requ'ired for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SY~.EM .; . '-. - ." . E~ INDIVIDUAL/ON-SITE** **If individual/or'-site, give installation date over 2 year. s .- ...- I~,system is over two (2) years (~ld an adequacy test is required [] POBLIC UTI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE ~NSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER' [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY E:] 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 UTILITY Connection Verified INSTALLER []Septic Tank or F~Holding Tank Size: If Tank is homemade SOILS RATING . : glve dimensions: TYPE OF TANK MANUFACTURER ' TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO; Septic/Holding Tank · Absorption Area Sewer Line I Nearost Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~- APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter mustA~ompany certificate) LEGAL DESORIPTION "-.. ' 72-010 (Rev. 3~78)