HomeMy WebLinkAboutWONDER PARK #1 BLK 3 LT 7LOT"
1@75
satisfactory 8f~er th~) up~rade ts cor~plet(:~d,
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received_ ~2_~
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Approval requested by:
Mailing Address:
Property Owner:
Mailing Address:
3. Legal Description: ,~7~
5. Type of facility to be inspected
Phone:
No. of bedrooms
6. Well Data:
C. Construction D. Bacterial Analysis
7. Sewage Disposal System:
A. Installed 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
Pag~ 2 of two pages - Reql ~ for Approval of Individual S( - & Water Facilities
Legal Description
Comments
Approved/~~ ~i ~-Disapproved
Date
Approval~Valid for one year from date signed
Greater Anchorage Ar~a 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) ]~
3330
P, IE(/IIIiSI' FOR API'f!OVA[ OF
li'll)lV[l)tlhl.. SEWER & W/\F[I( I-ACILIiIES
1. l'ype o¢
2. Property
Mail'ing Addresri:
3. Name of L~tly(~F:
Ilail in!j Address;
4. Hame
Inspecl;ion: CMP, 0 VA I:IiA CONV xx
01'lllf21': Aurora L. Loss ·
300 Geneive Circle Day I'hone '.
A~en L. Geisen and w~fe, Debra A. Ge&sen
~ox 7902, Anchorage, Ak D;.~ Phoue 864-i218 (¢¢~9/~
of t. ending [nstf Eution: The First National Bank of Anchorage * ~;'~'~'~%Z
Ilailing Address: P, o. Box 720, Anchorage, Ak.
..................... 995I-0
Hame of Rea] tot or Agent: None
Phone, 279-4481 x 231
Mai 1 ~ rig hddr'ess: ..... Phorle
Leqal Des(:Fip~iofl: Lot 7, Block 3, Nonder Park
LocatJorl: 310 Stewart, Anchorage, Alaska
Type of Facility ~o he inspected: ~ingle Faro. Res. Plo. Bdrms. 2
Water Su.)ply
Type oF Supply: Public Ut. ility Individual x
If Individual, number of dwellings presenLly served 1
If Individual, d;?[,E'h of well
Sewage Disposal. System
Type o System: Public
if Individual, daae
ULiliky ._x_ ..... l*ldivi,.lu,tl (on-site)
oF installation
Please forward results directly to lender, the First National Bank of Anchorage,
MUNICIPALITY OF ANCHORAGE
825 L Street - Anchorage. Alaska 99501
ENVIRONMENTAL EN6 NEERING DIVI$ ON
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND
SEP 1 9 1978
)IRI='CTIONS: Complete all parts on page 1. Incomplete requests will not be processeo, Please allow tel~ (10) davs for processing, '
MAILING ADDRESS
PROPERTY RESIDENT (If different from ebove} PHONE
2. BUYER PHONE
MAI LING ADDRESS
3. 'LENDING INSTITUTION
PHONE
MAILING ADDRESS
4. REALTOR/Aq~ENT
:K yw/gF
WALLING ADDRESS
PHONE
7zt /
S. LEGAL DESCRIPTI~)N
STREET LOCATION
E, TYPE OF RESIDENCE
.)5~ SINGLE FAMILY
[~ MULTIPLE FAMILY
7. WATER SUPPLY
"[~(' INDIVIDUAL*
[] COMMUNITY
[~ :'UBLIC UTILITY
NUMBER OF BEDROOMS
[] One [] Four [] Other
[] Two [] Five
~. Three [] Six
* ATTACH WELL LOG, A wel ~og is reeuired for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach og f available.) ~
S, SEWA(~4E DISPOSAL SYSTEM
[] NDIVIDUAL tON-SITE**
PUBLIC UTILITY
ndividual/on-slte, give installation date
system is over two (2) years old an adeouacy test is renulred
ov this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIA'rED.
72-01013/78)
THIS SIDE FOR OFFICIAL USE ONLY
'. DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR I NSP ECTOR 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
EZ] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[]Septic Tauk or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dlmensJons:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATER]AL
4. DISTANCESwELL TO: Septic/HoldingTank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Eot Line
5, COMMENTS
[]~;;]-'"~PP R OV E D FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
~ DISAPPROVED
DATE / (~ '-~C' '~.? BY (Title) ,~.~
LEGAL DESCRIPTION
72-010 (Rev, 3/78)