HomeMy WebLinkAboutWENTWORTH BLK 3 LT 18
M..,C,PAL,TYOFANC"ORAGE OF ^.C.O.^CE
TMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH &
~~ 825 L Street- Anchorage, Alaska 99501 ENVIRONMENT,AL PF;O'i'ECTION
ENVIRONMENTAL ENGINEERING DIVISION JAN 2 197g
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed please allow ten (10 days for processing.
1. PROPERTY OWNER PHONE
i PROPERTY RESIDENTs{If different from above)
PHONE
PHONE
3. ~ING INSTITUTION
PHONE
REALTOR/AGENT
I~,1 LIN G'Ab D'F{ ESS '
PHONE
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
I~l~ One ~ Four
[] SINGLE FAMILY [] Two '[] Five
~]~. MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
COMMUNITY
[] 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.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE*~'
'~1~ PUBLIC UTILITY
If system is over two (2) years old an adequacy test is required
by this D~partment.
72~310(3/78)NOTE: THE INSPECTION FEE MUSTi/ACCO~ EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
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
[] INDrVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
~31NDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
E~]Septic Tank or [] Holdin§ 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 Bewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (Fetter must accompany certificate)
[~D~ISAPPROVED
..--%
BY (Title)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
July 2]., ]970
~lr. C.D, Simon
3135 East 43rd
And~orage, Alaska 99504
SilB,~2CT: Inspection of Se~or
and !Water Facilities for Duplex,
Lot 18, Block 3, ~entwo~th Sub-
division
Dear ~. Simon:
At your request, personnel of this Department inspected the
sewer and water facilities for the subject duplex.
Water is supplied b)' a 60' drilled well which ~mets this
part~nt's approval. A water sample taken from this well
proved satisf~mtorT.
Although the sewer system d~s not meet this l~partnmnt~s
approval, it appears to be f~ction!ng satisfactorily.
prove.1 of the present sewer system for MIA or VA fin~cing
would be grm~ted providing flint funds are plaid i~ escrow
to c~nect to p~lic se~rs du~ng the 1971 construction
For further information, please contact this office.
Sincerely,
CLIFFORD P. JUDKINS, R.S.
/~tmin~trative Director
Smnitarian
GREATER ANCHORAG~ AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
REQUEST FOR APPROVAL OF
INDIVI'DUAL SEWER AND WATER FACILITIES
FOR
APPROVAL
ADDRESS:
REQUESTED BY:
PHONE:
2, PROPERTY OWNER:
3. LEGAL DESCRIPTION:
4. TYPE FACILITY TO BE INSPECTED:
NUMBER OF BEDROOMS:
5. WELL DATA:
A. TYPE
PHONE
B. DEPTH ~'~:
C. S I Z E ~ ~
,
D. CONSTRUCTION
SEWAGE DISPOSAL SYSTEM:
SEPTIC TANK
1. SIZE
2~ AGE
(IF HOMEMADE, SHOW DIAGRAM ON BACK)
~ ,: ,~?:~[ '?/.
3. MANUFACTURER
4. INSTALLER
APPROVAL REQUEST FOR SEWER
PAGE TWO
& WATER
FACILITIES
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE
E.
F.
G.
H.
WELL TO OTHER
FOUNDATION TO
FOUNDATION TO
SEEPAGE
COMMENTS:'
POSSIBLE CONTAMINATION
SEPTIC TANK
SEEPAGE PIT
PIT TO PROPERTY LINE
A PPROVED~ '~_~/~-,-~L ~/~/~DIS APPROVED
DATE: ?f DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT
OF ENVIRONMENTAL QUALITY
INDIVIDUAL SEWAGE AND WATER FACILITIES
(Fill out in Triplicate)
Name .of person requesting approval_ .t ,,
Numbe~'-,£.~bedrooms in house ~ . .. ~.' ~/3~ ~ ~ ,L~
.Wate~..3knaly~ is:
a. Bact~_ri~
b, Detergent,
W~1] data:
b,
d,
Distance from well to ose t exi
1.- Sewe~ line \
2. Septic tank ~~/~
3. Seepage Area ~~
4. Cesspool~...
5. Property Line
Other sources of possible contamination, i.e., creeks,
houses~ bar~, drainage ditch, etc.
lakes,
Sewage disposal system.
a. ,~ge of system
~y Septic tank ~apaclty in gallons
IF e. Name of septic tank manufaetu~e~
~ 1. If "home made" show diagram on reverse side of this form.
d.' Disposal field or seepage piz size and type
1. Distance ]zo, proper~y, lin house foundation
-e. Pemcola~ lea Te~ h~esults
~ ~. Percolation Test performed by ,,
se the Peverse .side of this for~ to 'how dla£ram, Dlafram should include
.... ~-~he following, info~mation: p~operty lineal.well location, house location,
~p~ic tank location, disposal area location, location of percolation test,
a~ direction of ground slope.
9. The l~for~a%ion .on this form is true and correct to the best of my knowledge.
Signature of Applicant
~te Sifn~d'
~9 BE FILLED OUT BY HEALTH DEPART~ENT PERSONNEL
above described sanitary facilities are hereby approved, subj.ec? to the
~l~owinf conditions: ....
The above described sanitary facilities are disapproved for the following
reasons:
....S~gnat' ' is~; : '"-"."' - .,/ - 'Date .:~," ~,-': ~ ~..:~,i
'--.Approval is valid for one year following the date of approval.
-~ CPJ:cw
GREATER ANCHORAGE AREA BorOUGH
June 17, 1970
G~AB Health Department
327 Eagle Street
Anchorage, Alaska 99501
Gentlemen:
SANITARY SE!~ER SERVICE ~ WENTWORTH SUBDIVISION LOT 18, BLOCK 3
This letter is to confirm that a Sanitary Lateral Improvement
District for ~entworth Subdivision has gone through preliminary
preparation and will be presented for Public Hearing at the Greater
Anchorage Area Borough Assembly meeting of July 13, 1970, for
Wentworth Subdivision.
After passage by the Assembly, this sanitary sewer line should be
constructed during the construction season of 1971, and would
serve Lot 18, Block 3 in the Wentworth Subdivision.
If you have 'further questions regarding this matter, please contact
this office.
Yours truly,
GREATER ANCHORAGE AREA BOROUGH
Department of Public Works
Robert H. Morriss, Director
Robert M. Hudnall, Jr.
Administrative Assistant
RMH/jt
cc: C. D. Simons