HomeMy WebLinkAboutWENTWORTH BLK 2 LT 21oo' ¢o'p5
#1: Time
Date
Insp
~ ~ ~UNICIPALITY OF ANCHORAGE '
DEPA~TMENI~,.-~F HEALTH AND ENVIRONMENTA~_~PROTECTION
825 L Street, Anchoraa~. Alaska 99501
264-4720
Date Received: October 24, 1977
~f~])~ ~2: Time #3: Time
10-2L~77 .~]~ Date Date
Willis Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: First Natioanl Bank of Anchorage % Marie
Mailing Address: Post Office Box 720 99510 Phone: 276-6300
¥~ 3.
4:
2. Property Owner: Laverra E. Burkes Phone: 344-8520
Mailing Address:
Legal Description:
% Duren, 13801 Venus Way
Lot 21 Block 2 Wentwo~$ubdivisi'on
3z2z ~:ast 4zn~ Avenue
Single Family Residence: ( )
Number of Bedrooms:
Multiple Family Residence: (x)
Number of Bedrooms: Four
o
Well System:
Permit #
Individual well (x~ Community~/.P~u~blic Syste~ ( )
Depth of Well 150' approx. W Log on File
Construction Bacterial Analysis
Sewage Disposal System: On-site System ~ Public utility
Permit 9 Installed ~ Installer
Septic Tank Size
Absorption Area
Manufacturer
Soils Rate Material
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 21 Block 2 Wentwork Subdivision
Comments:
Affadavit Attached: (') Letter Attached: ( )
Approved:
Disapproved
Date:
Date:
'Department Worksheet:
, , ,, ,
· :' , , ~ ,iUNICIPALITY OF ANCHORA E k ~ ~ "~0~,
~ Department of Health and Envzronmental Prot~q,t o~1
//~ 'r 8 2 ~ L Street, Anchorage, Alaska 99501
Mailing Address: ~ ~C'~,, /3~~/ /~X~ ~yPhone:
Name of Buyer: ~fJ~/~~
Mailing Address: ~'-~/ ~2~. ~'/~
Phone:
3. 'Lending Institution:
Mailing Address:
4. Realtor/Agent: ~~
Mailing Address: ~/
Phone:
Phone:
Legal Description:
Street Location:
Single Family Residence: ( ) Number of Bedrooms:
Multiple Family Residence: ~ Number of Bedrooms:
Water Supply: * Individual Well (~ Public/Community System ( )
If Individual Well, well depth ]~ ~ ~
If Community System, name of system
8. Sewage Disposal System: On-site System ( blic System
_On~site System, date of installation:
I~- *NO~E: ~ ~og is requirea on 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 request before processing
can be initiated.
3/77
TO Bowden Realty 301 East Fireweed Lane
SUBJECT ~,nclosed Check for Lot 21 Block 2 Wentwork DATE 10-20-77
Along with each check for sewer and water facilities approval the
request form must be attached with it. I have enclosed a request
form to be filled out as completely as possible. Then return it to
me with the check.
Thank you.
/
SEND PARTS I AND 3 WITH CARBON INTACT.
4S 469 PART 3 WILL BE RE4'URNED WITH REPLY.
^3330 "¢" Street, Anchorage, Alaska 99503 274-4561
· '~~ DateReceived~//~7/:~
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
5. Type of facility to be inspected
6. Well Data:
A. Type-~-
C. Construction
7. Sewage Disposal System:
A. Installed
No. of bedrooms
-- ~ B. Depth
0,~~/ ~ Analysis
B. Installer
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 - Re~.~st for Approval of Individual ~..jer & Water Facilities
Legal Description
Comments
A p p r o v ed ~ ~?~:::~o/_/~(~f?~m- .... Disapproved
Approval 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
E0-034