HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 2 LT 34
.~MUNICIPALITY OF ANCHORAGE
DEPARTM"' ]OF HEALTH AND ENVIRONME~-~ PROTECTION
82b?L Street, Anchorage, Ala~,,~ 99501
~/~11, ext. 224 or 22~
~4~~._ _. Date Received.I' June 15,
#2: Time #3:
Date
Insp
Time
Date
Insp
1977
Time
Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
l. Lending Institution Request: Alaska National Bank of the North
Mailing Address: Pouch 7010 99510 Phone: 277-5511
2. Property Owner:
l.lailing Address:
Clinton L. Laurin Phone: 694-9617
Box 19 Caribou Street 99577
3. Legal Description: Lot 34 Block 2 Eagle River Heights Subdivision
4: Single Family Residence: (~ Number of Bedrooms: three
Multiple Family Residence: ( ) Number of Bedrooms:
Well System: ,Individual well ~ ) Community/Public System ( )
.'7
Permit # Depth of Well Well Log on File
Construction ~ o
Bacterial Analysis
Sewage Disposal System: On-site S~ ~~/
Permit # Installed Installer
Septic Tank Size
Manufacturer
Absorption Area
Soils Rate
Material
Distances: Well to Septic Tank
to Sewer Line Nearest
to ~:earest Lot Line
Lot line
to Absorption Area
Absorption Area
825 L Street, Anchorage, AlasKa E9~...5~2;?'~,.~?~,1~-'~1
~:~quest for Approval of Individual Sewer and W~%~~itles
Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
RECEI_VED
Phone:
Phone:
3. Lending Institution:
Mailing Address:
Phone:
Se
Realtor/Agent:
Mailing Address:
Legal Description:
Street Location:
Single Family Residence: (~ Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
e
Water Supply: *Individual l~ell (~
If Individual Well, well depth
If Community System, name of system
Public/Community System ( )
8. Sewage Disposal System: On-site System ( ) Public System
If On-site System, date of installation:
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: ~ot ~4 Block 2 Eagle River Heiqhts Subdivision
Comments:
Affadavit Attached: ( ) Letter Attached:
Date:
Department Worksheet:
06-1220Ia) Rev. 1973
DATE
AL//"'"~)EPARTMENT OF HEALTH AND SOCIAL ..c'"~-'~ES
DIVISION OF PUBLIC HEALTH "
IHDIVIDUAL AND S£MI-PUBUC
BACTERIOLOGICAL WATER AHALYSIS
INDIVIDUAL ~ '~ SEMI.PUBLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
CO~L~E THIS SECTION
ONLY IF WAT~ I$ AN INDIVIDUAL SUPPLY
Sample Col'.,~ From ~ ~l~*n Top ~ 6oth,~m Tap '
LOCATION:
PURPOSE OF EXAMINATION: Illness Suspected? [] Yes
i-I noo.-,
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
OFFICE
SANITARIAN'S REMARKS
o~42~o (b) BACT-~RIOLOGICAL WATER ANALYSIS RECORD