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Home My WebLink AboutWENTWORTH BLK 1 LT 2815/oc GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR V.A. royal requested by: Alaska Statebank Date Received ?ebruary 12, 1976 Time of Inspection Date of Inspection ~-/O-Qf~ Mailing Address: 310 East Northern Lights Blvd. Phone: 279-7637 x 32 2. Property Owner: Daniel Horvath Phone: Mailing Address: 3. Legal Descriotion: Lot 28 Block 1 Wentworth Subdivision 4020 Dale Street 4. Location: o Type of facility to be inspected~ Duplex _ Well Data: Individual A. Type C. Construction Sewage Disposal System: A. Installed C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Field: Total length of lines No. of bedrooms B. Depth D. Bacterial Analys~s B. Installer Size 2. Manufacturer Absorption Area 2. Material , Absorption area , Other contamination , Absorption area Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line , Sewer Lines EQ-034 (1/~).~. Page I of two pages Page 2 of two pages ~ Req~-~t for Approval Of Individual S~.~r & Water Facilities L~gal DeScription T,ot 28 Blo~)~ i WentWort1~ St~bcl±vis±on App Valid 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) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES I. Type of Inspection: CMRO 2. Property Owner: DANIEL HORVATH VA XXXXXX FHA Mailing Address: Name of Buyer: ROBERT, STERN Day Phone CONV Mailing Address: 2060 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: Ollffside Drive ALASKA STATEBANK 310 E, Northern Llghta Area Realtors, ~577 C Street Contact Pat Korn for inspection Pat Korn Day Phone 277-3022 Phone 279-7637 ex 32 Phone Legal Description: _ Lot 28, BIk I Wentworth S/D Location:_ 4020 Dale Stre_e_t.. Anchorage, 7. Type of Facility to be inspected: Duplex 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well unknown 9, Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms. Individual XXXX Individual (on-site) XXXX EQ-037 (1/74) 4.1 Dear Sir~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO 2. 'Property Owner: Robert L. Stern VA ~ FHA CONV. Mailing Address: 2060 Clif£side Dr. Name of Buyer: Robert Stern Day Phone:277-0169 Mailing Address: 2060 Cliffside Dr. 4. Name of Lending Institution: Alaska Statebank Mailing Address: 310 E. Northern Lights Blvd. 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description:. Lot 28 Blk 1 Wentworth S/D Day Phone:277-0169 Phone: 279 ~637 _ Phone: Location: 4020 Dale St. Anchorage, Alaska 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Duplex . No. Bdrms. Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility ~ I f Individual, date of installation .Individual (on-site) 72-003(3/76) i. ~ REQUES~ FOR APPROVAL OF INDrVIDUAL SEWAGE AND WATER FACILITI~E~&o (Fill out in Triplicate) person requesting appm~val~ ~ 5. ;ate~. Analys~s: a. Bac'ta~.{.a l. b. Detemgent .... " W~I ] data: c. Casing Size_ /~ q Distance from well to closest existing or proposed: 1. Sewer line 2. Septic tank~ ~-j · 3, Seepage Ar. ea~-~~ . 4. Cesspool~ 5. Property Line__/~_/ . Other sources of possible contamination, i.e. ~ creeks, lakes, houses~ barn~ drainage ditch, etc. ~- 7. SewaKe disposal system. b, Septic tank capacity in gallon~.~ ~ ~ c. ~ame of septic tank manufactu~m 1. If "home made" show diagram on reverse Side of this form. d.' Disposal field or seepage pit size and type. ,~ 0~ d 1. Distance to pmopex~y lln~ ~--Z to house foundation ~ Q ?ercolat ±or~ Test Percolation Test performed by Use the reverse .side of this form to show diagram. Diagram should include [-t, he following information: p.roperty lines~ .well location, house location, r~ptie tank location, disposal area location, location of percolation test~ al;d, direction of ground slope. The J-~-F~)~.~t~on' on this form is true and correct to the best of my knowledge. 'Signature of Applicant ' ' Date Signed mO~BE~FILLED OUT BY HEALTH DEPART{.~ENT PEP, SONNEL ~Ti~e above described sanitary ac~l~t~es are hereby approved subject to the f ~'~"r°'llowing c on~'~i'~ons' Conditions The above described sanitary facilities are disapproved for the followinA ' SignAt~e "~' ~. ,~"?-.]7 Dat~ ;".: . ~;~.-%.;]. .Appr.oval is valid for one year following the date of approval. CPJ: cw 2. 3. q. 5, REQUEST~F INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) ~a~ of person requesting approval ~(am~_ of property owner/ , b. D~te;~en~, ; ~'"' , d. Distance f~om well to closest existinE o~ p~opo~9~: / ' 3. SeepaEe Area , . / 5. P~operty Line 6. Other sources of possible contamination, i.e.~ creeks, lakes, houses~ barn) drainage ditch~ etc. Sewage disposal system, a. Age of system ~¢_~ . b. Septic tank capacity in gallons c. Name of septic tank manufactu~gr 1. If "home made" show diagram on reverse side of this form. Disposal field or seepage pit size and type 1. Distance to property line to house foundation Pereo]~tionx, Test~esults .... f. Percolation Test performed by Use the reverse side of this form to show diagram. Diagra~ should include ~he foilowing information: ~operty lines~.well location, house location, ~ptic tank location, disposal area location, location of percolation test, aa~ direction of ground slope. The i~rfor~tlon On this folio, is true and correct to the best of my knowledge. /~ignature o~ Applicant ' ' ~atd Si~ned · ' \ TO BE FILLED OUT BY HEALTH DEPART~ENT PERSONNEL ~he above described sanitary facilities are hereby approved, subject to the ........ ~611ewing con~i~ons: Conditions: /~)~..~_ The above described sanitary aczlmt~es are disapproved for the following · "Signature of ~,~.iofA~.~,. ;' '. ~,.,' ,;. Date ;}~ J'i.~ :.~ i,], Approval is valid for one year following the date of approval. CPJ: cw