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Home My WebLink AboutT12N R3W SEC 9 LT 54 W100' S200'5re. APPLI. Mailing Address Address .NT FILLS OUT UPPER HA ' ONLY / Phone . /~ :f.''~, Zip Code Lending Institution /)~, 'T, ,,/, / ~, /~ ,,! ? //1/,- ~,, ~.. '! Realty Co, & Agen~ Address Zip Code Phone Phone Street Looatio. ,' Type of Residence .~- Single Family [] Multiple Family NO, of Dedrooms ,, J __ [] Other Water Supply ~ Individual ATTACH WELL LOG. A wc~l log is ~equired Ior all wells drilled since June 1975. [~ Community For wells drilled prior to that date, give well depth (attach log if available), ~1 Public Utility Sewer Disposal [] Individual Year Individual Installed: Public Utility ~,t~ (~.~.. [.r /._ When Connecled to Public Utility: Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCE-SSING CAN BE INITIATED, Date Date Date Date Inspector Inspector Inspector Inspecto~ ~ ~NVIRONM,~MTAL PROTECTION RECEIVED ( ~ APPROVED BEDROOMS OF APPROVAL ( ) CON,,~,ONA, WeP ~o Tank Septic Tank Size MUNICIPALIT.,Y OF ANCttORAGE lc / DEPARTMI=NT OF HEALTH [~ ENVIRONMENTAL PROTECTI® IPALITY OF ANCHORAGE 825 L Street - Anchorage, Alaska 99501 DEPT. OF HEALTH & ENVIRONMENTAL P~O[ECTION ENVIRONMENTAL ENGINEERING DIVISI ON Telephone 264-4720 NOV ? 19'78 DIRECTIONS= Compmtea i)arts on page 1, hlCOmpiete requests will no[ be processed. Please allow ten (10) days ferproc0ssin§. 1. PROP.~RTY eVeNER PHONE MAILING ADDRESS PROPERTY RESIDENT IIf different from above) ~. BUYER PHONE PHONE MAILING ADDRESS 4, REALTOR/AGENT MAILING ADDRESS 5. LE L DESCRIPTION STREET LOCATION 6. TYPE! OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NLJMBER OF BEDROOMS [~] One [~ Four [] Two [] Five ~] Three E~ Six ~HONE 9.qd,- qg5 ~'. WATER SUPPLY [] INDIVID)JAL* [] COMMUNITY [] PUBLIC UTILITY ~. SEWAGE DISPOSAL SYSTEM PHONE N DIVI DUAL/ON-SITE~ ~UBLIC [JTI LITY [] Otlter * ATTACH WELL LOG, A well log is required for a weus drilled since June 197~. For wells drilled ~rior to that date, g ve wel aeuth (attach og if available.) individual/on-site, give installation date svstem is over two (2) vear~ old an adeauecy test is requlrea by this DeDartment, NOTF: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~010(3/78) Tills 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 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 Connecticut Verified INSTALLER []Septic Tank or [] Holding 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 Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS " FPROVEOEOR BEDROOMS [] CONDITIONAL APPBOVAL {letter must accompany certificate) J~)ISAPPBOV ED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Ma~l~ng Address. -~ 0 '~ ~ Phone: 2. Property Owner: ~. ~~ Phone: Mailing Address: ~'~ ~. ,~~ ~-- 5. Type of facility to be i~spectedh~'-~ ~ ~ f bedrooms__ ~ _ 6. Well Data: ~. A. Type C. Construction Sewage Disposal System: B. Depth D. Bacterial Analysis A. Installed B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area 2. Manufacturer 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 GREATER ANCtIORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES I. Type of Inspection: CMRO VA FHA 2. Property Owner: carl Fannlng Maiqing Address: 31.17 East 84th Av~. AnchoragDay Phone 3. Name of Buyer: Bryan~ Harold D.~ M.D. Mailing Address: 211o B. Northern Lights Blvd_.. Day_ Phone Anchorag% Alaska 4. Name of Lending Institution: Coast Mortgage Co. Mailing Address: 4450 Business Park BIvd Phone 274 9504 Anchorag% AK 99504 5. Name of Realtor or Agent: Prank Jones Realty~ Zane Jones~ Realtor Mailing Address: 6118 Seward Highway Phone 344 2537 AJ~chorage, Alaska CONV xxx 344 8354 277 4535 o Legal Description: A portion of Lot 54~ Section 9~ Twp 12N~ Range 3 W~ S.M. Locati on: 3117 East 84th Avenu% Anchorag% Al( Type of Facility to be inspected: slngle family No. Bdrms. 3 Water Supply Type of Supply: Public Utility Individual x If Individual, number of dwellings presently served If Individual, depth of well 55' Sewage Disposal System Type of System: Public Utility If Individual, date of installation x Individual (on-site) EQ-037 i~age 2 of two pages - Re t for Approval of Individual · - & Water Facilities Legal Description ~,,),~,~q.~,~l 6].~ Comments ..... Approved _ _ Disapproved ApprovalNalid for one year from date signed Greater Anchorage Area Borough, Department of Environmental DIAGRAM OF SYSTEM Quality 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 GREATER ANCHORAGE ARL-.,', BOROUGH Department of Environmental Quality "C" St., Anchorage, Alaska 99503 ~ 274-4561 REQUEST FOR APPROVAl.. OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: ~ Mailing Address: 3. Nam- o'f Buyer: Mailing Address: .......... D~y Phone 4. Name of Lending Institution: Mailing Address: .... ~ ~:~ ./)~.'.~z,/,-' ~/~)/~'~/Phone ~' ~-' ~D~'- ' 5. Name o'F Realtor or Agent:~ ~ z-, ~ '~ ~]~,~ - .,-~ Mailing Address: .S-/~2 ~': Legal Description 7. Type of Facility 8. Water Supply Type of Supply: to be inspected: <z~__ ~m~c~ No. Bdrms. _-) Public Utility Individual If If Individual, depth of well .~-/ ' Sewage Disposal System Type .o'f S~stem: Public Utility z~-~' If Individual, date of installation Individual, number of dwellings presently served / Individual (on-site) Gl{EATER ANCHORAGE AREA BOROUGH Department of £nvironmental queltty 3500 'ruder Road, Anchorage, Alaska 99507 279-8686 Ti e of ne eotion_ Date of Insoectton REQUEST FOR APPROVAL OF INDIVIDUAL SHINER & WATER FACILITIES F OR Address: -Phone: Type of Facility to be ]:nspected: .... <~~6 Number of'Bedrooms: ...... A. Type ~' ___- . W¢.i¢~lZ A. Zns~a lled B. %ns~al let C, Septic Tank: 1, Size 2. Manufacturer D, Seepage Pit:: ].. Size 2, Material__. E Disposal. Field: Total Length of Lines Distances: A. Well To: Sept:lc Tank , Absorption Area , Sewer Lines , Nearest Lot line , Other Contamination g. Foundation to Septic 'rank Absorption Area C. Absorption Area to Nearest Lot Line ....... , GREATER ANCHORAGE AREA BOROUGtt Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FHA 2. Property Owner: Mai.ling Address: 31I.Y_ ~as ~ 3. Name of Buyer: _~ryan: Mailing Address: 2110 ]~~ts [!lvd._Da~ Phone AnchoJ:age~ Alaska 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Mailing Address: CONV _.xxx P I1 o n e~4_8~5_4 277 453~ 445OJ}u$iness Park Blvd _ Phone_ 274 9504 Ancherage, AK 99504 Ag en t: [~rank Jones Real. t]i,_ Za__ne Jones, Realto~r 6118 Sewar~Q llighway Anchorage, Alaska Phone 344 2537 Legal Description: A portion of Lot 54, Se__ction 9_~_T~rp_ 12N~ Range 3 W, Locati on: 3117 Bas% 84th.Avenue_. Type of Facility to be inspected: single~jj~_ No. Bdrms. ~ .... Water Supply Type of Supply: Public Utility Individual x If Individual, number of dwellings presently served If Individual, depth of well 55, Sewage Disposal System Type of System: Public Utility If Individual, date of installation x Individual (on-site) EQ-037 (1/74 Re~]est for Apprpval of Ir,,..vidual Sewer & Water Fac:[ltties Page Two 9. Comments~ /~:~' Aporova] Valid for One Year Prom Date Siqned G~eater Anchorage Area Borough, Department of Environmental quality DIAGRAM OF SYSTE~ Z certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water fac~.lities located Signed Date