HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 2 LT 22
MUNtCIPALITY OF ANCHORAGE r: L ;.
DEPARTMENT OF HEAt. TH & ENVIRONMENTAL PROTECTION
B25 L St~et o Andaml~, Aiasl~ g9501 t ;~ ~t ~.~
ENVIRONMENTAL ENGINEERING DIVISION ,
Tete~e ~7~ ~'~
REQU~ FOR ~PROVAL O~ I~DIVIDUAL WATER ~D ~EWER FAClLITIE~
PROPERTY OINNER ~ ~O~q ~' 6[~1d
MAILING ADDRESS
PROPERTY RESIDENT lit di~r~t fr~ ~)
~ BUYER
MAILING AODRESS
4. REALTOR/AGENT
PHONE ~..
PHONE
PHONE
LEGAL DESCRIPTION
'lo4 -z Z
~TREET LOCATION
TYPE OP RESIOENCE
~ SINGLE FAMILY
[::] MULTIPLE FAMILY
MSER OF BEDROOMS
I'-I One I-'1 Four
r-I Two [] Five
~ Three I-'1 Six
7. WATER EUPPLY
r-I COMMUNITY
I'-I PUBLIC UTI LITY
8. SEWAGE DISPQSAL SYSTEM
[] INDIVIDUAL/ON'SITE*'
PUBLIC UTILITY
[] Other
~-~'1'
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 197J~. For weils~l[[lled prior to that date, give well
d~'-~tech~og if available.) '
If md~wduel/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(3178)
K..,,.,
THIS SIDE FOR OFFICIAL USE ONLY .~
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
:)ATE DATE DATE
INSPE,.,¥O~ INSPECTOR INSPECTOR
DIRECTIONS:
: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
I'-'] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
I--I MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2: WATER SUPPLY PERMIT NUMBER
[] 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
Connection Verified
INSTALLER
I'--ISeptlcTenk or []HoldingTank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: SePt ic/Holdlng Ts n k IAb~orption Area lsd,*, Li,~ J Nm~t Lot Line
5. COMMENTS
[~FPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
LEGAL DESCRIPTION
72-0'i0 (Rev, 3/78)
P.O. BOX 4-1216 4C~9 BUSINESS PARK BLVD.
ANCIIORAGE, ALASKA ~'3503
Dfinklng Waler Analysis Repod for T~tal Coliform Badefia
TEI.£PHONE
{~'37) 2704014
TO BE COMPLETED BY WATER SUPPLIER
SA,.,PLEDATE: P"-Ffl E-I F21-TJ'
SAr,IPLE TYPE:
C] Routine
I.-J Check Sample (for routine sample
, with lab ref. no..
XSpecial Purpose ~ r,r,~ ~
Treated Water
Untreated Water
SAMPLE
NO. LOCATION
Time Collecled
Collecled By
TO BE COMPLETED BY LABORATORY
LABORATORY:
NAME
4649 BUSINESS PARK BLVD.
ADDRESS
.._ANCIiORAGE,_ALASI~
CITY
Dato Received .... _'~-J3-77
Time Receiveci g".:/--{.._._~_.-~ ~v~.
Analytical Method:
[::3 Fermentation Tube
~ Membrane Filter
Lab Ref. No. Result* Analyst
J E-J-.-'J
I I'-F-1
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
ro~r. No. 18.310 (3.78)
06.1220 (t))
Rev. 1978
8ACTIFRIOLOGICAL ¥¢ATER ANALYSIS RECORD
F.°.n~'2'~ !°Zv ...............
a~t~y~U~- -~.EATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561 ~
Date Received 3/1B/?S
Time of Inspection
Date of Inspection 3/18/75
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval 'requested by: 1st National Banlc o£Anchorage
Mailing Address: ~chorage ~J( Phone:
2. Property Owner: George Moore Jr. Phone: 694-9832
Mailing Address: General ~clivcry, Eagle River
3. Legal Description: Lot 22, Block 2 Eagle IL~ver tIeigkts
4. Location: Carribou Street
B. Type of facility.to be inspected Single No. of bedrooms 3
6. Well Data:
: A. Type Drilled B. Depth 90'
C. Construction Standard D. Bacterial Analysis
7. Sewage Disposal System: ?ublic ~ewer $Tstem.
A. Installed B. Installer
C. Septic Tank: I. 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
L~gal Description
Lot 22, Block 2, Eagle River }lci~hts
Co,~ents Appro,,red {or se~qer system only.
Approve ' /~,~'. Disapproved Date .i/3S/~S
Approval kValid for one year from date.signed
Greater Anchorage Area Borough, Department of Envlroc~,,ental 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)