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HomeMy WebLinkAboutWENTWORTH BLK 1 LT 2LoT MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPL ©F [!L'J TH & 82B L Street - Anchorage, Alaska 99501 EJqV'~RONMEiNI'AL F;,O~'ECTIOb4 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 i979 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE~I~IJ~IJr~j~ D ,IRECTIONS: Complete all parts on page 1, Incomplete reques~ will not be proceed. Please allow ten (10) days for processing. PHONE Thelma Shelton 272-4851 1. PROPERTY OWNER MAILING ADDRESS 3320 East 40th Avenue 99504 279-3284 PROPERTY RESIDENT(Ifdifferentfromabove) 1 PHONE 2. BUYER I PHONE Linda Swain 272-4851 MAILING ADDRESS 3320 East 40th Avenue 99504 3. LENDING INSTITUTION National Bank of Alaska MAILING ADDRESS Pouch 7-025 99510 4. REALTOR/AGENT PHONE PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION Lot 2 Block 1 Wentworth Subdivision -~R E ET LOCATION 3320 East 40th Avenue 99504 6. TYPEOF RESIDENCE NUMBER OF BEDROOMS [] One X~2[ Four [] Other__ [] SINGLE FAMILY [] Two [] Five :~ MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY ::~ INDIVi DUAL* * ATTACH WELL LOG. A well log is required 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 SYSTEM [] INDIVIDUAL/ON-SITE** [~ PUBLIC UTILITY individual/on-site, give installation date X~9~3K~K PLEASE VERIFY CONNECTION. 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 INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] 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 []Hold[ngTank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~],~-~APPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL {letter must a~npan¥ certificate) ~ D'SAPPROVED ~ DATE BY (Tit~e) .... ' LEGAL DESCRIPTION 72-010 (Rev. 3/78) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: ~ 2. Property Owner: Mailing Address: Legal Description: 4. Location: ~ ~ ~ 5. Type of facility to be inspected 6. Well Data: ~'~ ~ c7~ /~.~--~ No. of bedrooms C. Construction B. Depth ~z D. Bacterial Analysis Sewage Disposal System: ~x_~. ~ss ~ e~~ A. Installed ~ 1 C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 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 - Req~t st for Approval of Individual S~r & Water Facilities L~.gal (]escription ~_~ Z ~t //-'2~'2~/~/"~Jl -~/c~7/ Approved ~..~/~t ~/~?~ - Disapproved. Date Fi./? ~7/~ Approval Valid for one year from date signed Greater Anchorage Aria Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I 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) July 29, 1974 Edward ~!. Shelton Po O. Box 4-1314 Anchorage, Alaska 99509 SUBJECT: On-site sewer and water facilities serving Lot 2, ~)lock l l~entworth .ubdivl$ion - 3320 £a~t 40th Avenue Dear Mr. Shelton: The water system serving the subject property is via a private ~./ell. At your request, this Deparim~ent inspected the above well and found it to be in a pit. A reinspection made on Friday, July 19, t97,~, indicat;ed the well caslnq has been exten~ei.t above ground an~! no;.~' meets our requirements for fina~ approval. Sewage is disposed via Dorough Sewer System. .) i nce~ ely, C.l~. Sellers, Environmental Control O~-f~cer CFS/ko July 17, 1974 Mr. Bdward W. Shelton 3220 East 40th Avenue Anchorage, Alaska 99504 SUBJECT: On-site water system serving Lot 2, Block 1, ~entworth Subd. Dear Mr. Shelton: Upon your request the above facilities were inspected by this depar~nent on the loth of July 1974. At that time, it was noted that the water serving the property is via a private well which is in a pit north of the dwelling. The necessary upgrading on the subject well ~st be complete before this departx~ent can give its approval. The well casing must be brought up to 12" ~bove ground level. A sanitary seal is required on top of the casing and the pit must be filled with impervious soil. When the above is com- pleted then we will be happy to rei~tspec~ the. well. The se~,ler system serving the property is v&~ the Borough Sewer System. If you have any questions, please feel free to contact me at 274-4561. Sincerely, Charles F~ Sellers, Envlronmental Control Officer CFS/ko ~~ ' 264-4720 .~-~quest for Approval of In~ivi~u Water Facilities Property Owner: Mailing Address: Name of Buyer: Mailing Address: Phone: ~ ~ ?~- 3 ~/ Phone: Lending Institution: Mailing Address: ~ //_ ~-- ~ Phone: Realtor/Agent: Mailing Address: Legal Description: ~ ~ Street Location: Phone: o Single Family Residence: Multiple Family Residence: Number of Bedrooms: Number of Bedrooms: ~ (~ Public/Community System Water Supply: *Individual Well If Individual Well, well depth If Community System, name of system o Sewage Disposal System: *~n-site System ( ) Public System If On-site System, date of installation: ~/~z~'~J~' *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 test is required by this department. A fee of $25.00 must accompany each requeot before processing can be initiated. 3/77