HomeMy WebLinkAboutSMITHWAY LT 1DoT
i
PO'k_GH 6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit 4: 840646
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 1 Smithway Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as -built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
inccerely,
Keith E. Bandt, Supe visor
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
,
. .
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��� � � � ��L� �� ����������C3 1E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREETv ANCHORAGE, AK 99501
'264-4720 ~
PERMIT NO: 840646 '
DATE ISSUED: 07/31/84
APPLICANT: RONALD SQQLE
ADDRESS: 101 KNOWLE CIRCLE '
ANCHORAGE, AK 99515
CONTACT PHONE:` 344-6313'
'
LEGALDESCRIP: SUBDIVISION: SMITHWAY LOT: 1 BLOCK: N/A
SECTION: 25 TOWNSHIP: 13N RAN8E: 4W
LOT SIZE- 8721 (SQ.FT. OR ACRES)
I certify that:
1. I am familiar with the requirements for on --site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2"�I will install the system in accordance with all MOA codes and regulations.,' andin compliance with the design criteria of this permit.,
3. I will adhere to all MOA and State of Alaska requirements for the set back
.distances from any existing well, wastewater disposal system or public
sewerage system on thi I or any adjacent or nearby let.
SIGNED DATE: -
APPLICANT: RONALD SOULE �
ISSUED BY DATE:
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, �
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Time
APPLIC AT FILLS OUT UPPER HAI,-,.,ONLYa
qhs
Time
Date
S's CiLzon
laroperty Owner
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Phone
Mailing Address
'may) (�)£—`� r' 'I" - s� Zip Cade
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Buyer �r� Fcnnil CC -
Address
Zip Code
Inspector
Lending Institution
-
(.()IAYI 63j'1�J!> fJf'�(`i 1� fU(J [`C: ,
Phone
Address
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Realty Co. & Agent
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Phone
Address
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Code
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..-7Zip
Legal DescriptionLi-
i
- Well To Absorption Area
Well Log Received
Septic Tank Size
Street Location
000
Type of Residence
Single Family
-Multiple
Family
No. of Bedrooms_
❑ Other
Water Supply
❑ Individual
)c.
Z
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
L!kCommunity
P
For wells drilled prior to that date, give well depth (attach log
if available).
0 Public Utility
_may
Sewer Disposal
- -
❑ Individual
Year Individual Installed:
CPublic Utility
When Connected to Public Utility: ✓
0 }-folding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
`.1
Time
lid tea•.
Time
Date
Date
S's CiLzon
Dae
` IS
Dale
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Lo - q. -
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Inspector
Inspector
Inspector
Inspector
1r-dwl
Field Notes: �� MUNICIPALITY OF ANCHORAGE
i�EC l�l� P, ` L LLQP {U /_LDLO U --n4(2 C` .Nt, OF H`I,RO �:
ENVIRONf✓��NTAL PROT"eCTION
a AILD u� rvhs
�p
lud �L r rr)G✓ ' C3a(o% -t U [,LxLou V.
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�LI) �.- RECEIVED
ILU
(�) APPROVED BEDROOMS - - a •�,(j ONDITIONSOF APPROVAL_ - -
v..{,1
ti ! rJ' 3^ LQ 0�,
( ) DISAPPROVED
,"-- 1
( ) CO/N,D,ITIONAL APPROVAL'
DATE (� .. � j
BY: l j j C. f.�-1J1,'� _ \ "" S.'' C.� ,{,' (�0 10
�� � ry CV�Z�� •�� V1i-� i� u=`�` Cl
SoilsRatingDate
Sewer Installed
- Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
72023 (3182)