HomeMy WebLinkAboutWENTWORTH BLK 1 LT 11LoT
--~ i DATE RECEIVED
TIME TIME TIME
DATE DATE DATE
NSPECTOR
INSPECTOR
INSPECTOR
MUNICIPALITY OF ANCHORA~
ENVIRONMENTAL F~:OTECTION
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL SANITATION DIVISION RECEIVED
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) davs for processing.
MAILING A D DR E~SS /
PRQI~ERTY RESIDENZ(If different o ) . .~ PHONE
2 ~UYER/ ~ / // PHONE
MAILING ADDR~
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPEOF RESIDENCE NUMBER OF~SEDROOMS
[] One []~our
[] SINGLE FAMILY [] Two [] Five
[~/~U LTl PLE FAMI kY Z~-~.~./~.- [] Three [] Six
WATER SUPP
7. ~VIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
[] Other
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE**
~}"'~UBLIC UTI LITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) ,~ 1 (~%~
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
(~] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] 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 [] Holding Tank
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 Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[~APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must r~c~ompany certificate)
DATE ~' BY
72-010 (Rev, 6/79)
~ MUNICIPALITY OF ANCHORAGE ,-
~. ~ ~EPARTMEI~..,~)F HE<H &ND.,ENVIRONMI~i~_2_PROI'ECTI~AI~.
- ~ ~ 224 25
l. ~endin9 lns~i~u~Lon Request: ~i~s~ Federal Savings and Loan
e
Mailing Address:
Property Owner:
Mailing Address:
Post Office Box 4-2200 99509 p!~on{:
Edward L./Elizabeth M Davi Phone:
3304 Iowa Drive ~4 99503
274-6561
279-0984/274-0251
Legal Description: Lot 11 Block 1 Wentworth Subdivision
:5~:3~r~ast 40~-h---A-venue
Single Family Residence: (x)
Number of Bedrooms: 4
Multiple Family Residence: ( )
Number of Bedrooms:
Well System: Individual Well (x) Community/Public System (
Permit #~z~/~/~,~ Depth of Well Well Log on File
Construction ~ Bacterial Analysis ~ ~
Sewage
Permit
Septic Tank Size
Absorption Area
DJ. sposal System:
On-site System ( ) Public U%ility
Installed Installer
Manufacturer
Soils Rate Material
(x)
Distances: Well to Septic
to Sewer Line
to Nearest Lot Line
Tank
Nearest Lot line
to Absorption Area
Absorption Area
Page Two
Department of Health and Environmental Protection
Request for Approval of'Individual Sewer and Water Facilities
Legal Description: Lot 11 Block 1 Wentworth Subdivision
Affadavit Attached: ( ) Letter Attached: ( )
Approved:
Disapproved: Date:
bepartment Worksheet
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
oo.~,. .~ Ctreot. Anchorage, Alaska 99503 --
'r z.''
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA
2. Property Owner: Dav±s~ Bdwarcl L. & gl±gabeth ~.
FHA CONV XX×
Mailing Address:
Name of Buyer:
3304 Iowa Drive Apt. #4
Same
Day Phone
279-0984
Mailing Address:
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
Day Phone
First Federal Savings and Loan Assn. of Anchorage
P 0 Box 4-2200 Anch. Ak. 99509Phone 274-6561
None
Phone
6. Legal Description: Lot 11, Blk 1, Wentworth S/D
Location:
3130 East 40th Avenue
Anchorage Alaska 99504
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply:
Duplex
Public Utility
If Individual, number of dwellings presently served
if Individual, depth of well 90 ft.
9. Sewage Disposal System
Type of System: Public Utility x×
If Individual, date of installation
./~l[~)an Off icer
~E~z037 (1/74)
No. Bdrms.
Individual
Individual (on-site)
k__OR~ATER ~NCHOR~GE AREA BOROUGH
['-.~ ~L~] DEP~R/~'~NT
$27 EAGLE ST.~ET
;~NCHORAGE, ALASKA 99S01
279-2Sll
DATE UrCeIVED ~'--/q- ~/ .
TI~E:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AMD lqATER FACILITIES
FOR
1. Approval Requested By, ~
Property Owner
Legal Description
T~e of ~acility to be Inspecte~~RE~T:
Number of Bedrooms
C. Size ~/
E. Bacterial Analysis~
'Sewage Disposal System:
A, Septic Tank (If,h.omem~e, show diagram on back)
1. Size
^~e /q~
Manufacturer
4, Installer
Al~prov~l ~Request for Se~x_z~ ~ Water Facilities
Page Two
=.
C.
D.
E.
F.
G.
H.
Seepage Pit
2. Lining
C. _,Disposal Field
1. Number of Lines
2. Total Length
Required Measurements
Well to Septic Tank
Well to Seepage Pit
Well to Sewer Line
Well to Property Line
Nell to Other Possible Contamination
Foundation to Septic Tank
Foundation to Seepage Pit
Seepage Pit to Property Line
CO~4ENTS:
APPROVAL VALID FOR ONE YEAR FROH DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH HEALTH DEPART~.~EI'~
EDll70
Subjectl Sewer and ~oter Systems for Duplex on Lot
Block 1, ~entworth Subdivision.
An inspection of the sewer and water systems was mode on the
~ubject lot. I[ was discovered the[ the semi-public well is
only 9~ feet fram the see~ege area. For approval of this
semi-public well the well needs to be 120 feet fro~ the
Approval for the well by this office can be given when the
duplex is connected to the aereu,~h se~.r .hich [e scheduled
~e be installed within s six month period. Approval would
also ~e contingent upon · re-sampling of tho well,
{f yOU have any questions, reOsrdin~ the abase, please do not
hesitate to contact this office.
Sincerely,
Lynn
Sanitarian
dc! 7etersn's Admintstratiun
~y
GH~LSS W. EOGE~ZON
6801 GHESOKEE W~r
~NCHORA GE, AL2 SKA
99504
i7, 1971
~. RALPH ST~ICKDAND
OREATE~ ~NCHOI~AGE ~l~E~4 ~OROUGH
$£7 EAGLE'
~NCHORAGE~ ~LASI{A
MS PER OUR TELEPHONE CONYEt~SATION OF ]~ARCH 17,
I DO HEREBY AGREED TO CONNECT HOUSE AT 3311-41S. T ~4YE
~O~OUGH SEWEI~ LINE AS SOON AS LINE
A~EA~ THIS AGREEMENT IS CONTINGENT
TITLE T~ANSFEi~ TO MY N~4ME.
TO
IS ]~IADE ~7AILABLE IN
UPON CO~IPLETION OF
RESPEC TI V~~