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Home My WebLink AboutWENTWORTH BLK 2 LT 20 L_, ~-' :>,,P n n:7--' MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHO~GE PROTECtiON DEPT. 0 LI , & DEPARTMENT OF HEALTH & ENVIRONMENTAL ~NVIRONi,~.:NTAL ~;::: ECTION 825 L Street - Anchorage, Alaska 09501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND ~IRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE MAI LING AD DRESS 1. PROPERTY OWNER PROPERTY RESIDENT (If different from above) PHONE PHONE ~ 7~/?~ 2. BUYER MAI LING ADDR ESS 3, LENDING INSTITUTION MAILING ADDRESS 4. REALTOR/AGENT I PHONE 7'/~u~ 2-- · AdA-/x/o~/c~_ PHONE 5. LEGAL DESCRIPTION ~o~ ~o STREET LOCATION 32/1 /:,~ S7- 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY ,~ Two [] Five [] · MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDuAL/oN-SITE** [~ PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ~0" **If individual/on-site, give installation date if system is over two (2) years old an adequacy test is required 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 INSPECTOR 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 [] 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 Connect[on 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 [Z~I-~C~PP ROVE D FOR m.__~. BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) []DISAPPROVED /'2 DATE BY (Title) LECALDESCRIPTION 72-010 (Rev. 3/78) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Dec. 15, 1975 Approval requested by: Mailing Address: 2. Property Owner: Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. Alaska Housing Finance Company 902 West Northern Lights James Adams Bouleva~one: 274-4621 Phone: 344-5430 Mailing Address: 3. Legal Description: Lot 20 Block 2 Wentworth Subdivision 4. Location: About 2 blocks N of Tudor Road, east of Piper Street 5. Type of facility to be inspected Single Family No. of bedrooms 2 '6. Well Data: Individual A. Type ~z~ B. Depth 53' Analysis {W~, t~ C. Construction/~/~ D. Bacterial 7. Sewage Disposal System: Public Utility B. Installer A. Installed C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank Nearest lot line , Absorption area Other contamination , Sewer Lines , B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) [ . Page I of two pages Page 2 of two pages - Ret t for Approval of Individual S r & Water Facilities ~ · · Lot 20 Block 2 Went~vorth Subdivision Legal Description Comments Approved Disapproved Date/~-~f ~Pl~oval 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 reoresentatiop of the subject sewer and water facilities and these facilities are operating satisfactorily. Date SIGNED EQ-034 (1/74) MUNICIPALITY OF ANCHORAG~ GREATER ANCNORAGE AREA BOROUGH .... DEPARTMENT OF HEALTH & I~NVIRONMENTAL PROTECTION Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 27z~-41~l~,~lgTmu~.vlOo REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES RECEIVED 1. Type of Inspection: 2. Property Owner: Mai-ling Address: Name of Buyer: ~__~fO~.e~. ~/~~ Mailing Address: CMRO VA FHA ~- Day 4. Name Mailing Address: 5. Name of Realtor or.Agent: Day CONV // Phone Phone o of Lending Institution: ~/~ /~z~.~,~ /~- ' / Phone Mailing Address: Legal Description: ,,~,~ 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently If Individual, depth of well ~z--~ 9. Sewage Disposal System Type of System: Public Utility J// Individual served Individual (on-site) If Individual, date of installation £q-037 (]/74) Time -,} L , Time ~....~e Date Date Date Inspector Inspector Inspector Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS LOWER HALF ONLY Property Owner ~ O~ O~ ~" d ~e~ k ~ ~' Phone Address LegalDesoription ~)~o'~ ~, ~O¢ ~0 Street Location Type~f Residence ~Single Family ~ Multiple Family No. of Bedrooms ~ Other Wate~Supply ~'lndividual A~ACH WELL LOG. A well Icg is required for all wells drilled since June g Community 1975, For wells drilled prior to that date, give well depth (attach Icg if ~ Public Utilit~ available.) Sewage Disposal ~lndividual Year Individual Installed: ~PubJic Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,